Provider Demographics
NPI:1669976619
Name:ILEIHNO BOPACHEMIHN, INC.
Entity type:Organization
Organization Name:ILEIHNO BOPACHEMIHN, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:CURTIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-296-4522
Mailing Address - Street 1:4343 MARCONI AVENUE
Mailing Address - Street 2:SUITE 6
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95821-4343
Mailing Address - Country:US
Mailing Address - Phone:916-571-5060
Mailing Address - Fax:855-447-2658
Practice Address - Street 1:2312 PAMELA LANE
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95825
Practice Address - Country:US
Practice Address - Phone:916-692-8172
Practice Address - Fax:916-692-8178
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-22
Last Update Date:2018-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children