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2130 Stockton Blvd Buildings 100, 200 Sacramento CA 95817-1337 | |
| (916) 875-1086 | |
| (916) 874-9400 |
| Full Name | |
|---|---|
| Speciality | Clinic/center - Adult Mental Health |
| Location | 2130 Stockton Blvd, Sacramento, California |
| Authorized Official Name and Position | Ryan Quist (DEPUTY DIRECTOR) |
| Authorized Official Contact | 9168759904 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
7001a East Pkwy Suite 400 Sacramento CA 95823-2501 Ph: (916) 875-4948 | 2130 Stockton Blvd Buildings 100, 200 Sacramento CA 95817-1337 Ph: (916) 875-1086 |
| NPI Number | 1215003835 |
|---|---|
| Provider Enumeration Date | 11/27/2006 |
| Last Update Date | 10/26/2020 |
| Certification Date | 10/26/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1215003835 | NPI | - | NPPES |
| 34CZ | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0850X | Clinic/center - Adult Mental Health | (* (Not Available)) | Primary |
| 261QM0855X | Clinic/center - Adolescent And Children Mental Health | (* (Not Available)) | Secondary |
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