Provider Demographics
NPI:1063700656
Name:ANKA BEHAVIORAL HEALTH, INC.
Entity type:Organization
Organization Name:ANKA BEHAVIORAL HEALTH, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SENIOR QM MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:GINA
Authorized Official - Middle Name:M
Authorized Official - Last Name:VYROSTEK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:925-825-4700
Mailing Address - Street 1:1850 GATEWAY BLVD
Mailing Address - Street 2:SUITE 900
Mailing Address - City:CONCORD
Mailing Address - State:CA
Mailing Address - Zip Code:94520-8414
Mailing Address - Country:US
Mailing Address - Phone:925-825-4700
Mailing Address - Fax:805-653-5974
Practice Address - Street 1:350 HILLMONT AVENUE
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003
Practice Address - Country:US
Practice Address - Phone:805-233-7750
Practice Address - Fax:805-653-5974
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-16
Last Update Date:2015-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD05511203323P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility