MEDICARE: DRUG ABUSE ALTERNATIVES CENTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency	490009BN	CA
2	324500000X	Substance Abuse Rehabilitation Facility	490009RN	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	490009BN	OTHER	CA	DADP CERTIFICATION
2	49490700	OTHER	CA	MEDICAL

General Provider Information

NPI Number	:	1518024389
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DRUG ABUSE ALTERNATIVES CENTER

Provider Business Mailing Address
First Line	:	2403 PROFESSIONAL DRIVE
Second Line	:	SUITE 102
City	:	SANTA ROSA
State	:	CA
Zip	:	95403-3007
Country	:	US
Telephone Number	:	707-571-2233
Fax Number	:	707-571-2238

Provider Business Practice Location Address
First Line	:	2403 PROFESSIONAL DR
Second Line	:	SUITE 102
City	:	SANTA ROSA
State	:	CA
Zip	:	95403-3007
Country	:	US
Telephone Number	:	707-571-2233
Fax Number	:	707-571-2238

Authorized Official
Title or Position	:	CENTER POINT VICE PRESIDENT, DAAC M
Name	:	MR. JOHN CHALLIS
Credential	:
Telephone Number	:	707-571-2233

Provider Enumeration Date	:	01/02/2007
Last Update Date	:	01/25/2016

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