| Pine Grove Program | |
|
674 Allard Ave Eureka CA 95503-5857 | |
| (707) 268-2900 | |
| Not Available |
| Full Name | Pine Grove Program |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 674 Allard Ave, Eureka, California |
| Authorized Official Name and Position | Donna Wheeler (MENTAL HEALTH DIRECTOR) |
| Authorized Official Contact | 7072682990 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Pine Grove Program 720 Wood St Eureka CA 95501-4413 Ph: (707) 268-2990 | Pine Grove Program 674 Allard Ave Eureka CA 95503-5857 Ph: (707) 268-2900 |
| NPI Number | 1700904547 |
|---|---|
| Provider Enumeration Date | 03/27/2007 |
| Last Update Date | 07/21/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1700904547 | NPI | - | NPPES |
| 000001228 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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