MEDICARE: ANKA BEHAVIORAL HEALTH, 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	:	1689125163
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANKA BEHAVIORAL HEALTH, INC.

Provider Business Mailing Address
First Line	:	3480 BUSKIRK AVE STE 300
Second Line	:
City	:	PLEASANT HILL
State	:	CA
Zip	:	94523-4343
Country	:	US
Telephone Number	:	925-082-5470
Fax Number	:	925-825-2610

Provider Business Practice Location Address
First Line	:	2428 WARLOW LN
Second Line	:
City	:	STOCKTON
State	:	CA
Zip	:	95206
Country	:	US
Telephone Number	:	209-689-0311
Fax Number	:	209-337-2104

Authorized Official
Title or Position	:	VP OF QM
Name	:	STEPHEN HAHN-SMITH
Credential	:
Telephone Number	:	209-689-0311

Provider Enumeration Date	:	10/19/2016
Last Update Date	:	07/03/2018

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