Provider Demographics
NPI:1164646048
Name:TRANSITIONAL RESIDENTIAL TREATMENT FACILITIES
Entity Type:Organization
Organization Name:TRANSITIONAL RESIDENTIAL TREATMENT FACILITIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:L
Authorized Official - Last Name:DUNCAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:707-444-8123
Mailing Address - Street 1:PO BOX 6299
Mailing Address - Street 2:
Mailing Address - City:EUREKA
Mailing Address - State:CA
Mailing Address - Zip Code:95502-6299
Mailing Address - Country:US
Mailing Address - Phone:707-444-8213
Mailing Address - Fax:707-444-3715
Practice Address - Street 1:1010 W HENDERSON ST
Practice Address - Street 2:
Practice Address - City:EUREKA
Practice Address - State:CA
Practice Address - Zip Code:95501-3545
Practice Address - Country:US
Practice Address - Phone:707-444-8213
Practice Address - Fax:707-444-3715
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness