| NPI | 1952685414 |
|---|---|
| Doing Business As | CODAC SANTA ROSA |
| Entity Type | Organization |
| Authorized Contact | DENNIS REGNIER CEO 520-327-4505 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0855X Clinic/Center, Adolescent and Children Mental Health (Licence: AZ BH-3922) |
| Enumeration Date | 2011-10-03 |
| Last Update Date | 2015-09-25 |