Provider Demographics
NPI: | 1932251410 |
---|---|
Name: | ANKA BEHAVIORAL HEALTH, INC. |
Entity Type: | Organization |
Organization Name: | ANKA BEHAVIORAL HEALTH, INC. |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | CHIEF MEDICAL OFFICER |
Authorized Official - Prefix: | DR |
Authorized Official - First Name: | NZINGA |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | HARRISON |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | MD |
Authorized Official - Phone: | 925-825-4700 |
Mailing Address - Street 1: | 3480 BUSKIRK AVE STE 300 |
Mailing Address - Street 2: | |
Mailing Address - City: | PLEASANT HILL |
Mailing Address - State: | CA |
Mailing Address - Zip Code: | 94523-4343 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 925-825-4700 |
Mailing Address - Fax: | 925-825-2610 |
Practice Address - Street 1: | 3480 BUSKIRK AVE STE 300 |
Practice Address - Street 2: | |
Practice Address - City: | PLEASANT HILL |
Practice Address - State: | CA |
Practice Address - Zip Code: | 94523 |
Practice Address - Country: | US |
Practice Address - Phone: | 925-825-4700 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | Yes |
Parent Organization LBN: | ANKA BEHAVIORAL HEALTH, INC. |
Parent Organization TIN: | <UNAVAIL> |
Enumeration Date: | 2007-01-17 |
Last Update Date: | 2018-07-03 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
CA | 251B00000X, 251C00000X, 251K00000X, 251S00000X, 320600000X, 320800000X, 320900000X, 322D00000X, 323P00000X, 324500000X | |
251S00000X | ||
CA | 96067920 | 251S00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 251S00000X | Agencies | Community/Behavioral Health | |
No | 251B00000X | Agencies | Case Management | |
No | 251C00000X | Agencies | Day Training, Developmentally Disabled Services | |
No | 251K00000X | Agencies | Public Health or Welfare | |
No | 320600000X | Residential Treatment Facilities | Residential Treatment Facility, Intellectual and/or Developmental Disabilities | |
No | 320800000X | Residential Treatment Facilities | Community Based Residential Treatment Facility, Mental Illness | |
No | 320900000X | Residential Treatment Facilities | Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities | |
No | 322D00000X | Residential Treatment Facilities | Residential Treatment Facility, Emotionally Disturbed Children | |
No | 323P00000X | Residential Treatment Facilities | Psychiatric Residential Treatment Facility | |
No | 324500000X | Residential Treatment Facilities | Substance Abuse Rehabilitation Facility |