Provider Demographics
NPI:1578603247
Name:ANKA BEHAVIORAL HEALTH, INC.
Entity Type:Organization
Organization Name:ANKA BEHAVIORAL HEALTH, INC.
Other - Org Name:HILLMONT HOUSE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF MEDICAL OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:NZINGA
Authorized Official - Middle Name:
Authorized Official - Last Name:HARRISON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:925-825-4700
Mailing Address - Street 1:3480 BUSKIRK AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:PLEASANT HILL
Mailing Address - State:CA
Mailing Address - Zip Code:94523-4343
Mailing Address - Country:US
Mailing Address - Phone:925-825-4700
Mailing Address - Fax:925-825-2610
Practice Address - Street 1:1750 S LEWIS RD
Practice Address - Street 2:
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93012
Practice Address - Country:US
Practice Address - Phone:805-765-9050
Practice Address - Fax:805-765-9073
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ANKA BEHAVIORAL HEALTH, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-02-08
Last Update Date:2018-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251S00000X, 320800000X
CA02015028251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness