Provider Demographics
NPI:1457505497
Name:EMANI INCORPORATED
Entity Type:Organization
Organization Name:EMANI INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DEPUTY DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MONIQUE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:N/A
Authorized Official - Phone:707-421-1200
Mailing Address - Street 1:200 PEPPERCORN CT
Mailing Address - Street 2:
Mailing Address - City:VALLEJO
Mailing Address - State:CA
Mailing Address - Zip Code:94591-8028
Mailing Address - Country:US
Mailing Address - Phone:707-421-1200
Mailing Address - Fax:707-421-1200
Practice Address - Street 1:420 E O ST
Practice Address - Street 2:
Practice Address - City:BENICIA
Practice Address - State:CA
Practice Address - Zip Code:94510-2861
Practice Address - Country:US
Practice Address - Phone:707-297-6393
Practice Address - Fax:707-297-6445
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-04
Last Update Date:2008-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA480029BN324500000X
CA480029AN324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility