1811030877 NPI number — COUNTY OF SANTA CLARA

Table of content: (NPI 1811030877)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811030877 NPI number — COUNTY OF SANTA CLARA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COUNTY OF SANTA CLARA
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:
DEPARTMENT OF ALCOHOL AND DRUG SERVICES
Provider Other Organization Name Type Code:
3
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:
1811030877
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/08/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
976 LENZEN AVE
Provider Second Line Business Mailing Address:
3RD FLOOR
Provider Business Mailing Address City Name:
SAN JOSE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95126-2737
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
408-792-5680
Provider Business Mailing Address Fax Number:
408-947-8702

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1331 E CALAVERAS BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MILPITAS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95035-5707
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
408-719-5063
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/15/2007

Additional Information

Authorized Official

Authorized Official Last Name:
COPLEY
Authorized Official First Name:
BRUCE
Authorized Official Middle Name:
Authorized Official Title or Position:
DEPARTMENT DIRECTOR
Authorized Official Telephone Number:
408-792-5680

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 434387 . This is a "STATE PROVIDER NUMBER" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 4387 . This is a "DRUG MEDI-CAL NUMBER" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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