1144396938 NPI number — COUNTY OF SACRAMENTO

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144396938 NPI number — COUNTY OF SACRAMENTO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COUNTY OF SACRAMENTO
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
CHILD AND ADOLESCENT PSYCHIATRIC SERVICES
Provider Other Organization Name Type Code:
5
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1144396938
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/29/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7001A EAST PKWY
Provider Second Line Business Mailing Address:
SUITE 400
Provider Business Mailing Address City Name:
SACRAMENTO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95823-2501
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
916-875-4948
Provider Business Mailing Address Fax Number:
916-875-6970

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3331 POWER INN RD
Provider Second Line Business Practice Location Address:
SUITE 140
Provider Business Practice Location Address City Name:
SACRAMENTO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95826-3889
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-876-6600
Provider Business Practice Location Address Fax Number:
916-875-0972
Provider Enumeration Date:
11/26/2006

Additional Information

Authorized Official

Authorized Official Last Name:
QUIST
Authorized Official First Name:
RYAN
Authorized Official Middle Name:
Authorized Official Title or Position:
DEPUTY DIRECTOR
Authorized Official Telephone Number:
916-875-9904

Provider Taxonomy Codes

  • Taxonomy code: 261QM0850X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QM0855X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 34BB , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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