Organization
NIRVANA DRUG AND ALCOHOL TREATMENT INSTITUTE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MICHAEL EDWARD BAGLEY CADC II, NADC, SAP (CFO)
(209) 579-1151
Entity
Organization
Contact information
Practice address
1116 ALICE ST, MODESTO, CA 95350-5905
(209) 578-3132
(209) 578-3498
Mailing address
1100 KANSAS AVE, SUITE B, MODESTO, CA 95351-1596
(209) 579-1151
(209) 579-9605
Taxonomy
Speciality
Code
Description
License number
State
324500000X
Substance Abuse Rehabilitation Facility
Primary
500009GN
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
500009GN
DEPARTMENT OF HEALTH CARE SERVICES
CA
Enumeration date
03/03/2016
Last updated
03/03/2016
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