Provider Demographics
NPI:1043462864
Name:PANACEA SERVICES, INC. AT LAGUNA CREEK HIGH SCHOOL
Entity Type:Organization
Organization Name:PANACEA SERVICES, INC. AT LAGUNA CREEK HIGH SCHOOL
Other - Org Name:
Other - Org Type:
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, CADC II, CAMF
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:
Practice Address - Street 1:9050 VICINO DR
Practice Address - Street 2:
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95758-5859
Practice Address - Country:US
Practice Address - Phone:916-854-4564
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PANACEA SERVICES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-10-13
Last Update Date:2008-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health