Provider Demographics
NPI:1336576222
Name:PANACEA SERVICES INC.
Entity Type:Organization
Organization Name:PANACEA SERVICES INC.
Other - Org Name:PANACEA SERVICES INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SUBSTANCE ABUSE COUNSELOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:HOLLY
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:BELTRAN
Authorized Official - Suffix:
Authorized Official - Credentials:BA, RAS
Authorized Official - Phone:916-223-3682
Mailing Address - Street 1:3336 BRADSHAW RD
Mailing Address - Street 2:315
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95827-2615
Mailing Address - Country:US
Mailing Address - Phone:916-854-4564
Mailing Address - Fax:
Practice Address - Street 1:3336 BRADSHAW RD
Practice Address - Street 2:315
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95827-2615
Practice Address - Country:US
Practice Address - Phone:916-854-4564
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-09
Last Update Date:2013-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty