=====================================================
General NPI Number Information
=====================================================
NPI Number | 1932528452
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ALCOHOL DRUG AND MENTAL HEALTH
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/11/2014
-----------------------------------------------------
Last Update Date | 04/11/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4444 CALLE REAL
-----------------------------------------------------
City | SANTA BARBARA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93110-1002
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 805-681-4794
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4444 CALLE REAL
-----------------------------------------------------
City | SANTA BARBARA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93110-1002
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 805-681-4794
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CASE MANAGER
-----------------------------------------------------
Name | MRS. ROSALINDA D NEVAREZ
-----------------------------------------------------
Credential | MFTI
-----------------------------------------------------
Telephone | 805-681-4794
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251B00000X
-----------------------------------------------------
Taxonomy Name | Case Management Agency
-----------------------------------------------------
License Number | 72329
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------