Basic Information
| Provider Information | |||||||||
| NPI: | 1063812097 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PANACEA SERVICES, INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3152 N MILLBROOK AVE # D&E | ||||||||
| Address2: | |||||||||
| City: | FRESNO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 937031400 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 3990 BRANCH CENTER RD | ||||||||
| Address2: | |||||||||
| City: | SACRAMENTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 958273809 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9168544564 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/27/2014 | ||||||||
| LastUpdateDate: | 08/27/2014 | ||||||||
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| AuthorizedOfficialLastName: | COWINGS | ||||||||
| AuthorizedOfficialFirstName: | PHILLIP | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO/PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 5592410364 | ||||||||
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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 | 251S00000X | Y | Agencies | Community/Behavioral Health |
No ID Information.