Basic Information
| Provider Information | |||||||||
| NPI: | 1316129372 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SLO COUNTY DRUG & ALCOHOL SERVICE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1106 E GRAND AVE | ||||||||
| Address2: | SUITE A | ||||||||
| City: | ARROYO GRANDE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 934202516 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8054737080 | ||||||||
| FaxNumber: | 8054737188 | ||||||||
| Practice Location | |||||||||
| Address1: | 1106 GRAND AVE | ||||||||
| Address2: | |||||||||
| City: | ARROYO GRANDE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 934202516 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8054737080 | ||||||||
| FaxNumber: | 8054737188 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/03/2007 | ||||||||
| LastUpdateDate: | 12/03/2007 | ||||||||
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| AuthorizedOfficialLastName: | POWELL | ||||||||
| AuthorizedOfficialFirstName: | MADALYN | ||||||||
| AuthorizedOfficialMiddleName: | BETHANN | ||||||||
| AuthorizedOfficialTitleorPosition: | SPECIALIST 1 | ||||||||
| AuthorizedOfficialTelephone: | 8054737083 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | RAS | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | CA | Y | Agencies | Community/Behavioral Health |
No ID Information.