| Full Name | |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 453 1st St, Woodland, California |
| Authorized Official Name and Position | Rose Macisaac (CFO) |
| Authorized Official Contact | 7607676435 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
Po Box 1260 Davis CA 95617-1260 Ph: (530) 753-3498 | 453 1st St Woodland CA 95695-4023 Ph: (530) 753-3498 |
| NPI Number | 1366091191 |
|---|---|
| Provider Enumeration Date | 09/04/2019 |
| Last Update Date | 10/17/2023 |
| Certification Date | 10/17/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1366091191 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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