Provider Demographics
NPI:1447737333
Name:ELK GROVE REHAB & COUNSELING CENTER
Entity Type:Organization
Organization Name:ELK GROVE REHAB & COUNSELING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PA
Authorized Official - Prefix:MR
Authorized Official - First Name:KIRK
Authorized Official - Middle Name:JAY
Authorized Official - Last Name:AUSTIN
Authorized Official - Suffix:
Authorized Official - Credentials:PA
Authorized Official - Phone:916-385-4438
Mailing Address - Street 1:7807 LAGUNA BLVD STE 480
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95758-7953
Mailing Address - Country:US
Mailing Address - Phone:916-385-4438
Mailing Address - Fax:916-897-2184
Practice Address - Street 1:7807 LAGUNA BLVD., SUITE 480
Practice Address - Street 2:
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95758
Practice Address - Country:US
Practice Address - Phone:916-385-4438
Practice Address - Fax:916-897-4438
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-24
Last Update Date:2018-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty