Provider Demographics
NPI:1497926505
Name:GIFTED HEALING CENTER INC
Entity Type:Organization
Organization Name:GIFTED HEALING CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ERNEST
Authorized Official - Middle Name:EUGENE
Authorized Official - Last Name:MOTLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:916-421-1500
Mailing Address - Street 1:2251 FLORIN RD SUITE 133
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95822
Mailing Address - Country:US
Mailing Address - Phone:916-421-1500
Mailing Address - Fax:916-421-1500
Practice Address - Street 1:2251 FLORIN RD STE 133
Practice Address - Street 2:7654 22ND STREET HOUSE OF UMOJA/RAFA PORJECT
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95822-4491
Practice Address - Country:US
Practice Address - Phone:916-421-1500
Practice Address - Fax:916-421-1500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-17
Last Update Date:2011-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA340066BN251S00000X, 320800000X, 324500000X
261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No251S00000XAgenciesCommunity/Behavioral Health
No320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA14979226505Medicare PIN