Provider Demographics
NPI:1255419172
Name:MEDMARK TREATMENT CENTERS - SACRAMENTO, INC.
Entity type:Organization
Organization Name:MEDMARK TREATMENT CENTERS - SACRAMENTO, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP, TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:
Authorized Official - Last Name:JARVIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-379-3300
Mailing Address - Street 1:1720 LAKEPOINTE DR STE 117
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75057-6425
Mailing Address - Country:US
Mailing Address - Phone:214-379-3300
Mailing Address - Fax:214-379-3324
Practice Address - Street 1:7240 E SOUTHGATE DR
Practice Address - Street 2:SUITES B, E, G
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95823-2627
Practice Address - Country:US
Practice Address - Phone:916-391-4293
Practice Address - Fax:916-391-4247
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MEDMARK SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-11-01
Last Update Date:2024-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA34-09261QM2800X, 261QM2800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2800XAmbulatory Health Care FacilitiesClinic/CenterMethadone
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA9390237OtherMEDICAL
CA34-09OtherOTP LICENSE
CA9390237OtherMEDICAL