Provider Demographics
NPI:1497137400
Name:ANKA BEHAVIORAL HEALTH
Entity Type:Organization
Organization Name:ANKA BEHAVIORAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SENIOR QM MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:GINA
Authorized Official - Middle Name:M
Authorized Official - Last Name:VYROSTEK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:925-270-2101
Mailing Address - Street 1:PO BOX 1173
Mailing Address - Street 2:
Mailing Address - City:OAKLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94561-1173
Mailing Address - Country:US
Mailing Address - Phone:925-698-5328
Mailing Address - Fax:
Practice Address - Street 1:610 DEVONSHIRE LOOP
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:CA
Practice Address - Zip Code:94513-2619
Practice Address - Country:US
Practice Address - Phone:925-698-5328
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-25
Last Update Date:2015-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable