1780448936 NPI number — FAIR OAKS BEHAVIORAL HEALTH INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780448936 NPI number — FAIR OAKS BEHAVIORAL HEALTH INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FAIR OAKS BEHAVIORAL HEALTH INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1780448936
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/08/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 60074
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SACRAMENTO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95860
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
916-761-3162
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7844 MADISON AVE STE 172
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FAIRBANKS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95862
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-823-8459
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/08/2024

Additional Information

Authorized Official

Authorized Official Last Name:
COLLVER-HORVATH
Authorized Official First Name:
JOSHUA
Authorized Official Middle Name:
LEE
Authorized Official Title or Position:
CLINICAL DIRECTOR/OWNER/FOUNDER
Authorized Official Telephone Number:
916-761-3162

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2024 www.npivalidator.com