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Kelly Ferreira
Substance Abuse Rehabilitation Facility in Crockett, California
NPI 1629445085

Kelly Ferreira is a Substance Abuse Rehabilitation Facility based in Crockett, CA. Kelly Ferreira practices in Crockett, CA. The NPI Number for Kelly Ferreira is 1629445085 and holds a License No. C2080275 (California).

The current practice location address for Kelly Ferreira is 715 Port St Apt 2, Crockett, CA and can be reached out via phone at 510-860-6324.

Location: 715 Port St Apt 2, Crockett, CA, 94525-1120
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1629445085
Provider Name
Kelly Ferreira
Credential
Provider Entity Type
Individual
Gender
Male
Address
715 Port St Apt 2, Crockett, CA, 94525-1120
Phone Number
510-860-6324
Fax Number
Provider Enumeration Date
09/01/2015
Last Update Date
03/09/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
C2080275 05 CA
institution
Provider Business Practice Location Address Details
Address
715 Port St Apt 2
City
Crockett
State
California
Zip
94525-1120
Phone Number
510-860-6324
Fax Number
person
Provider Business Mailing Address Details
Address
715 Port St Apt 2
City
Crockett
State
California
Zip
94525-1120
Phone Number
510-860-6324
Fax Number
person
Provider's Taxonomy Details 1
Type
Residential Treatment Facilities
Classification
Substance Abuse Rehabilitation Facility
Speciality
-
Taxonomy
324500000X
License No.
C2080275 (California)
Definition
A facility or distinct part of a facility that provides a 24 hr therapeutically planned living and rehabilitative intervention environment for the treatment of individuals with disorders in the abuse of drugs, alcohol, and other substances.
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