Provider Demographics
NPI:1780448936
Name:FAIR OAKS BEHAVIORAL HEALTH INC.
Entity type:Organization
Organization Name:FAIR OAKS BEHAVIORAL HEALTH INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR/OWNER/FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:COLLVER-HORVATH
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:916-761-3162
Mailing Address - Street 1:PO BOX 60074
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95860
Mailing Address - Country:US
Mailing Address - Phone:916-761-3162
Mailing Address - Fax:
Practice Address - Street 1:7844 MADISON AVE STE 172
Practice Address - Street 2:
Practice Address - City:FAIRBANKS
Practice Address - State:CA
Practice Address - Zip Code:95862
Practice Address - Country:US
Practice Address - Phone:916-823-8459
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-08
Last Update Date:2024-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty