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General NPI Number Information
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NPI Number | 1902236797
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Entity Type | Organization
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Legal Business Name | PANACEA SERVICES, INC.
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Dates
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Enumeration Date | 11/15/2013
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Last Update Date | 11/15/2013
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Provider Practice Location Address
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Address Line | 5437 PALM AVE
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City | SACRAMENTO
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State | CA
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Zip | 95841-2317
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Country | US
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Telephone | 559-854-4564
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Fax |
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Provider Business Mailing Address
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Address Line | 3152 N MILLBROOK AVE STE D
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City | FRESNO
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State | CA
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Zip | 93703-1459
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Country | US
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Telephone | 559-241-0364
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MR. PHILLIP COWINGS
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Credential |
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Telephone | 559-241-0364
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 340064AP
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License Number State | CA
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