Basic Information
| Provider Information | |||||||||
| NPI: | 1932251410 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ANKA BEHAVIORAL HEALTH, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3480 BUSKIRK AVE STE 300 | ||||||||
| Address2: | |||||||||
| City: | PLEASANT HILL | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945234343 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9258254700 | ||||||||
| FaxNumber: | 9258252610 | ||||||||
| Practice Location | |||||||||
| Address1: | 3480 BUSKIRK AVE STE 300 | ||||||||
| Address2: | |||||||||
| City: | PLEASANT HILL | ||||||||
| State: | CA | ||||||||
| PostalCode: | 94523 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9258254700 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/17/2007 | ||||||||
| LastUpdateDate: | 07/03/2018 | ||||||||
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| AuthorizedOfficialLastName: | HARRISON | ||||||||
| AuthorizedOfficialFirstName: | NZINGA | ||||||||
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| AuthorizedOfficialTitleorPosition: | CHIEF MEDICAL OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 9258254700 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | ANKA BEHAVIORAL HEALTH, INC. | ||||||||
| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 320600000X | CA | N | Residential Treatment Facilities | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 320800000X | CA | N | Residential Treatment Facilities | Community Based Residential Treatment Facility, Mental Illness | 320900000X | CA | N | Residential Treatment Facilities | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 322D00000X | CA | N | Residential Treatment Facilities | Residential Treatment Facility, Emotionally Disturbed Children | 251B00000X | CA | N | Agencies | Case Management | 251C00000X | CA | N | Agencies | Day Training, Developmentally Disabled Services | 251K00000X | CA | N | Agencies | Public Health or Welfare | 251S00000X | CA | N | Agencies | Community/Behavioral Health | 251S00000X | N | Agencies | Community/Behavioral Health | 323P00000X | CA | N | Residential Treatment Facilities | Psychiatric Residential Treatment Facility | 324500000X | CA | N | Residential Treatment Facilities | Substance Abuse Rehabilitation Facility | 251S00000X | 96067920 | CA | Y | Agencies | Community/Behavioral Health |
No ID Information.