Provider Demographics
NPI:1851543672
Name:PANACEA SERVICES, INC. AT THE WILLIAMS ACADEMY
Entity Type:Organization
Organization Name:PANACEA SERVICES, INC. AT THE WILLIAMS ACADEMY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TRISHA
Authorized Official - Middle Name:
Authorized Official - Last Name:SEASTROM
Authorized Official - Suffix:
Authorized Official - Credentials:BA, CADC II, CAMF
Authorized Official - Phone:916-854-4564
Mailing Address - Street 1:3353 BRADSHAW RD
Mailing Address - Street 2:SUITE 106
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95827-2607
Mailing Address - Country:US
Mailing Address - Phone:916-854-4564
Mailing Address - Fax:
Practice Address - Street 1:6524 44TH ST
Practice Address - Street 2:SUITE 204
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95823-1265
Practice Address - Country:US
Practice Address - Phone:916-854-4564
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PANACEA SERVICES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-10-13
Last Update Date:2008-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health