Provider Demographics
NPI:1477738862
Name:PANACEA, INC
Entity Type:Organization
Organization Name:PANACEA, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:
Authorized Official - Last Name:GOLDEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-241-0364
Mailing Address - Street 1:1617 E SAGINAW WAY
Mailing Address - Street 2:SUITE 109
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93704-4458
Mailing Address - Country:US
Mailing Address - Phone:559-241-0364
Mailing Address - Fax:559-241-0342
Practice Address - Street 1:4928 E CLINTON WAY
Practice Address - Street 2:SUITE 108
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93727-1526
Practice Address - Country:US
Practice Address - Phone:559-241-0364
Practice Address - Fax:559-241-0342
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PANACEA, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-01-03
Last Update Date:2008-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health