Provider Demographics
NPI:1225581382
Name:COMPREHENSIVE ADDICTION PROGRAM
Entity Type:Organization
Organization Name:COMPREHENSIVE ADDICTION PROGRAM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COUNSELOR 1
Authorized Official - Prefix:
Authorized Official - First Name:ROLAND
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-264-5096
Mailing Address - Street 1:9080 E DINUBA AVE
Mailing Address - Street 2:
Mailing Address - City:SELMA
Mailing Address - State:CA
Mailing Address - Zip Code:93662-9405
Mailing Address - Country:US
Mailing Address - Phone:559-477-3399
Mailing Address - Fax:
Practice Address - Street 1:9080 E DINUBA AVE
Practice Address - Street 2:
Practice Address - City:SELMA
Practice Address - State:CA
Practice Address - Zip Code:93662-9405
Practice Address - Country:US
Practice Address - Phone:559-477-3399
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-25
Last Update Date:2016-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101YA04000X324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility