Provider Demographics
NPI:1235689290
Name:ADCS WOMEN'S RESIDENTIAL
Entity Type:Organization
Organization Name:ADCS WOMEN'S RESIDENTIAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:BERNARD
Authorized Official - Last Name:MCMANUS
Authorized Official - Suffix:
Authorized Official - Credentials:CATC
Authorized Official - Phone:707-445-1391
Mailing Address - Street 1:2109 BROADWAY STE A
Mailing Address - Street 2:SUITE A
Mailing Address - City:EUREKA
Mailing Address - State:CA
Mailing Address - Zip Code:95501-2106
Mailing Address - Country:US
Mailing Address - Phone:707-445-1391
Mailing Address - Fax:707-445-2599
Practice Address - Street 1:1742 J ST
Practice Address - Street 2:
Practice Address - City:EUREKA
Practice Address - State:CA
Practice Address - Zip Code:95501-2648
Practice Address - Country:US
Practice Address - Phone:707-442-2232
Practice Address - Fax:707-442-2232
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ALCOHOL DRUG CARE SERVICES, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-10-13
Last Update Date:2016-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA120009CN324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA120009CNOtherDEPT OF HEALTH CARE SERVICES