Provider Demographics
NPI:1811395288
Name:PACIFIC CENTER FOR ADDICTION SERVICES INC.
Entity Type:Organization
Organization Name:PACIFIC CENTER FOR ADDICTION SERVICES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:FEICHT
Authorized Official - Suffix:
Authorized Official - Credentials:MPA
Authorized Official - Phone:209-887-3069
Mailing Address - Street 1:PO BOX 8372
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95208-0372
Mailing Address - Country:US
Mailing Address - Phone:209-227-7467
Mailing Address - Fax:209-932-9694
Practice Address - Street 1:808 N CENTER ST
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95202-1610
Practice Address - Country:US
Practice Address - Phone:209-227-7467
Practice Address - Fax:209-932-9694
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-16
Last Update Date:2014-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA390036AN324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA390036ANOtherDEPARTMENT OF HEALTH CARE SERVICES- AOD COUNSELING SERVICES