Provider Demographics
NPI:1760106405
Name:CRISIS ALTERNATIVE RESPONSE OF EUREKA
Entity Type:Organization
Organization Name:CRISIS ALTERNATIVE RESPONSE OF EUREKA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MENTAL HEALTH CLINICIAN
Authorized Official - Prefix:MR
Authorized Official - First Name:JACOB
Authorized Official - Middle Name:DANIEL
Authorized Official - Last Name:ROSEN
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:707-382-2445
Mailing Address - Street 1:531 K ST
Mailing Address - Street 2:
Mailing Address - City:EUREKA
Mailing Address - State:CA
Mailing Address - Zip Code:95501-1165
Mailing Address - Country:US
Mailing Address - Phone:707-441-4144
Mailing Address - Fax:
Practice Address - Street 1:531 K ST
Practice Address - Street 2:
Practice Address - City:EUREKA
Practice Address - State:CA
Practice Address - Zip Code:95501-1165
Practice Address - Country:US
Practice Address - Phone:707-441-4144
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CITY OF EUREKA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-09-27
Last Update Date:2022-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty
No171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty