Basic Information
| Provider Information | |||||||||
| NPI: | 1578807202 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | DRUG ABUSE ALTERNATIVES CENTER | ||||||||
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| OtherOrganizationName: | BROOKWOOD OPT CLINIC | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2403 PROFESSIONAL DRIVE | ||||||||
| Address2: | SUITE 102 | ||||||||
| City: | SANTA ROSA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 954033007 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7075712233 | ||||||||
| FaxNumber: | 7075712238 | ||||||||
| Practice Location | |||||||||
| Address1: | 983 SONOMA AVENUE | ||||||||
| Address2: | |||||||||
| City: | SANTA ROSA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 954044818 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7075838700 | ||||||||
| FaxNumber: | 7073031085 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/19/2012 | ||||||||
| LastUpdateDate: | 12/31/2015 | ||||||||
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| AuthorizedOfficialLastName: | CHALLIS | ||||||||
| AuthorizedOfficialFirstName: | JOHN | ||||||||
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| AuthorizedOfficialTitleorPosition: | CENTER POINT VICE PRESIDENT, DAAC M | ||||||||
| AuthorizedOfficialTelephone: | 4155262943 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QR0405X | Y | Ambulatory Health Care Facilities | Clinic/Center | Rehabilitation, Substance Use Disorder |
No ID Information.