Organization
EVOLUTION OF A BLACK BUTTERFLY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
FAREN JOHNSON (CEO)
(916) 218-8367
Entity
Organization
Contact information
Practice address
7335 MEADOWGATE DR, SACRAMENTO, CA 95823-2473
(916) 218-8367
Mailing address
5960 S LAND PARK DR # 1108, SACRAMENTO, CA 95822-3313
(916) 426-6642
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
—
—
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
R1245580317
SUBSTANCE ABUSE
CA
Enumeration date
09/17/2021
Last updated
09/17/2021
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