NPIMap

Nahrain Colleen Benner, SUDCC- II CS 11072

Individual provider Active NPI Student in an Organized Health Care Education/Training Program · Ceres, CA

NPI 1801323936 · NPPES record last updated Aug 28, 2025

Key facts

NPI
1801323936
Entity type
Individual (NPI type 1)
Primary specialty
Student in an Organized Health Care Education/Training Program 390200000X
Practice address
1904 Richland Ave
Ceres, CA 95307-4562
Phone
(209) 541-2121
NPI assigned
May 19, 2017
Sex
Female
Sole proprietor
No

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

Practice roles

OrganizationSpecialtyStatusNew patients
Aegis Treatment Centers, LLC Past Accepting new patients
Aegis Treatment Centers, LLC Past Accepting new patients

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) Counselor 101YA0400X
Student in an Organized Health Care Education/Training Program 390200000X CA Yes

Addresses

Primary practice location

1904 Richland Ave
Ceres, CA 95307-4562

Mailing address

10100 Trinity Pkwy
Stockton, CA 95219-7238
Phone (209) 953-3700

Other providers in Ceres, CA

All providers in Ceres, CA · Student in an Organized Health Care Education/Training Program in California

Sources for this page

Verify at the official NPI Registry.