Provider Demographics
NPI:1023380581
Name:PANACEA SERVICES, INC.
Entity Type:Organization
Organization Name:PANACEA SERVICES, INC.
Other - Org Name:PANACEA SERVICES, INC. HIRAM JOHNSON HIGH SCHOOL
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:TRISHA
Authorized Official - Middle Name:
Authorized Official - Last Name:SEASTROM
Authorized Official - Suffix:
Authorized Official - Credentials:BA, LAADC
Authorized Official - Phone:916-854-4564
Mailing Address - Street 1:3353 BRADSHAW RD
Mailing Address - Street 2:SUITE 106
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95827-2607
Mailing Address - Country:US
Mailing Address - Phone:916-854-4564
Mailing Address - Fax:916-857-1580
Practice Address - Street 1:6879 14TH AVE
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95820-3431
Practice Address - Country:US
Practice Address - Phone:916-854-4564
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-31
Last Update Date:2012-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health