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NPI Code Detail

MEDICARE: MR. THOMAS EUGENE RIDDLE CADC II

MEDICARE: MR. THOMAS EUGENE RIDDLE CADC II
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
1101YA0400XAddiction (Substance Use Disorder) CounselorA3735599CA

General Provider Information

NPI Number : 1922124361
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. THOMAS EUGENE RIDDLE CADC II
Provider Business Mailing Address
First Line : PO BOX 4856
Second Line :
City : AUBURN
State : CA
Zip : 95604-4856
Country : US
Telephone Number : 530-823-8129
Fax Number :
Provider Business Practice Location Address
First Line : 145 BOST AVE
Second Line :
City : NEVADA CITY
State : CA
Zip : 95959-3249
Country : US
Telephone Number : 530-265-9045
Fax Number : 530-478-7977
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/21/2007
Last Update Date : 07/08/2007

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