Provider Demographics
NPI:1902236797
Name:PANACEA SERVICES, INC.
Entity Type:Organization
Organization Name:PANACEA SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:PHILLIP
Authorized Official - Middle Name:
Authorized Official - Last Name:COWINGS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-241-0364
Mailing Address - Street 1:3152 N MILLBROOK AVE STE D
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93703-1459
Mailing Address - Country:US
Mailing Address - Phone:559-241-0364
Mailing Address - Fax:
Practice Address - Street 1:5437 PALM AVE
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95841-2317
Practice Address - Country:US
Practice Address - Phone:559-854-4564
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-15
Last Update Date:2013-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA340064AP251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health