Organization
NIRVANA DRUG AND ALCOHOL INSTITUTE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DANE HELDING (EXECUTIVE DIRECTOR)
(209) 579-1151
Entity
Organization
Contact information
Practice address
1028 RENO AVE, MODESTO, CA 95351-1127
(209) 579-1103
(209) 578-1085
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
50009EN
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
500009EN
DEPARTMENT OF ALCOHOL AND DRUG PROGRAMS
CA
Enumeration date
07/24/2010
Last updated
05/25/2012
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