Provider Demographics
NPI:1235360686
Name:NATOMAS SERVICE CENTER
Entity Type:Organization
Organization Name:NATOMAS SERVICE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:G
Authorized Official - Last Name:HILL
Authorized Official - Suffix:
Authorized Official - Credentials:ASSOCIATE DEGREE
Authorized Official - Phone:916-454-4242
Mailing Address - Street 1:3291 TRUXEL RD STE 26
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95833-1065
Mailing Address - Country:US
Mailing Address - Phone:916-808-6503
Mailing Address - Fax:
Practice Address - Street 1:3307 BROADWAY STE 200
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95817-2847
Practice Address - Country:US
Practice Address - Phone:916-454-4242
Practice Address - Fax:916-454-2930
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SACRAMENTO BLACK ALCOHOLISM CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-08-03
Last Update Date:2009-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA340008AN101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA340008ANOtherMEDI-CAL