Provider Demographics
NPI:1922248269
Name:THE EFFORT DETOX
Entity Type:Organization
Organization Name:THE EFFORT DETOX
Other - Org Name:THE FAMILY LIFELINE
Other - Org Type:Other Name
Authorized Official - Title/Position:ADMINSTRATION
Authorized Official - Prefix:MISS
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:EDWARDS
Authorized Official - Suffix:
Authorized Official - Credentials:CAS I
Authorized Official - Phone:916-405-4612
Mailing Address - Street 1:7586 STOCKTON BLVD
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95823-3923
Mailing Address - Country:US
Mailing Address - Phone:916-405-4612
Mailing Address - Fax:916-405-4620
Practice Address - Street 1:7586 STOCKTON BLVD
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95823-3923
Practice Address - Country:US
Practice Address - Phone:916-405-4612
Practice Address - Fax:916-405-4620
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE EFFORT FAMILY LIFELINE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-02-26
Last Update Date:2009-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101YAO4OOX324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAC343411OtherTHE EFFORT DETOX