Provider Demographics
NPI:1164852471
Name:PANACEA SERVICES, INC.
Entity Type:Organization
Organization Name:PANACEA SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:PHILLIP
Authorized Official - Middle Name:
Authorized Official - Last Name:COWINGS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-241-0364
Mailing Address - Street 1:3152 N MILLBROOK AVE
Mailing Address - Street 2:SUITE D
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93703-1400
Mailing Address - Country:US
Mailing Address - Phone:559-241-0364
Mailing Address - Fax:
Practice Address - Street 1:250 DOS RIOS ST STE A1
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95811-0442
Practice Address - Country:US
Practice Address - Phone:916-930-0066
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-22
Last Update Date:2013-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health