MEDICARE: PANACEA, INC

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

General Provider Information

NPI Number	:	1588848824
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PANACEA, INC

Provider Business Mailing Address
First Line	:	2745 N HUGHES AVE
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93705-3726
Country	:	US
Telephone Number	:	559-241-0364
Fax Number	:	559-241-0342

Provider Business Practice Location Address
First Line	:	2745 N HUGHES AVE
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93705-3726
Country	:	US
Telephone Number	:	559-241-0364
Fax Number	:	559-241-0342

Authorized Official
Title or Position	:	DIRECTOR
Name	:	CAROLYN GOLDEN
Credential	:
Telephone Number	:	559-241-0364

Provider Enumeration Date	:	12/21/2007
Last Update Date	:	12/21/2007

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Directions to “PANACEA, INC ” Practice Location

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