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General NPI Number Information
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NPI Number | 1881563500
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Entity Type | Organization
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Legal Business Name | WATERS OF PEACE HOUSE, LLC
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Dates
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Enumeration Date | 10/31/2025
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Last Update Date | 10/31/2025
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Provider Practice Location Address
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Address Line | 1125 HODGSON ST
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City | EUREKA
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State | CA
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Zip | 95503-5438
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Country | US
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Telephone | 707-601-9648
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Fax |
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Provider Business Mailing Address
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Address Line | 1125 HODGSON ST
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City | EUREKA
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State | CA
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Zip | 95503-5438
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Country | US
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Telephone | 707-601-9648
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MISS DANA LYNN HOLCOMB
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Credential | SUDCC11,NMAT
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Telephone | 707-601-9648
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number |
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License Number State |
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