Provider Demographics
NPI:1215204276
Name:NIRVANA DRUG AND ALCOHOL
Entity Type:Organization
Organization Name:NIRVANA DRUG AND ALCOHOL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DANE
Authorized Official - Middle Name:T
Authorized Official - Last Name:HELDING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:209-579-1151
Mailing Address - Street 1:1100 KANSAS AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95351-1596
Mailing Address - Country:US
Mailing Address - Phone:209-579-1151
Mailing Address - Fax:209-579-9605
Practice Address - Street 1:1100 KANSAS AVE STE BC&D
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95351-1596
Practice Address - Country:US
Practice Address - Phone:209-579-1151
Practice Address - Fax:209-579-9605
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NIRVANA DRUG AND ALCOHOL INSTITUTE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-11-18
Last Update Date:2019-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation FacilityGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA500009CNOtherDEPARTMENT OF HEALTH CARE SERVICES