Provider Demographics
NPI:1467739003
Name:ALCOHOL DRUG CARE SERVICES,INC.
Entity Type:Organization
Organization Name:ALCOHOL DRUG CARE SERVICES,INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:JACK
Authorized Official - Last Name:CUNNINGHAM
Authorized Official - Suffix:
Authorized Official - Credentials:CAS
Authorized Official - Phone:707-445-1391
Mailing Address - Street 1:528 5TH ST
Mailing Address - Street 2:
Mailing Address - City:EUREKA
Mailing Address - State:CA
Mailing Address - Zip Code:95501-1033
Mailing Address - Country:US
Mailing Address - Phone:707-445-1391
Mailing Address - Fax:707-445-2599
Practice Address - Street 1:528 5TH ST
Practice Address - Street 2:
Practice Address - City:EUREKA
Practice Address - State:CA
Practice Address - Zip Code:95501-1033
Practice Address - Country:US
Practice Address - Phone:707-445-1391
Practice Address - Fax:707-445-2599
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-10
Last Update Date:2011-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA120009AN324500000X
CA120009CN324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility