Provider Demographics
NPI:1255076873
Name:SORREL LEAF HEALING CENTER INC
Entity type:Organization
Organization Name:SORREL LEAF HEALING CENTER INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DEVELOPMENT LEAD
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:707-267-7812
Mailing Address - Street 1:124 INDIANOLA RD
Mailing Address - Street 2:
Mailing Address - City:EUREKA
Mailing Address - State:CA
Mailing Address - Zip Code:95503-9403
Mailing Address - Country:US
Mailing Address - Phone:707-267-7812
Mailing Address - Fax:
Practice Address - Street 1:124 INDIANOLA RD
Practice Address - Street 2:
Practice Address - City:EUREKA
Practice Address - State:CA
Practice Address - Zip Code:95503-9403
Practice Address - Country:US
Practice Address - Phone:707-267-7812
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-28
Last Update Date:2022-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health