1831435221 NPI number — EL DORADO MENTAL HEALTH

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 1831435221 NPI number — EL DORADO MENTAL HEALTH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EL DORADO MENTAL HEALTH
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:
Provider Other Organization Name Type Code:
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:
1831435221
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/13/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
935B SPRING ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PLACERVILLE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95667-4523
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
530-621-6213
Provider Business Mailing Address Fax Number:
530-622-2385

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
935B SPRING ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PLACERVILLE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95667-4523
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-621-6213
Provider Business Practice Location Address Fax Number:
530-622-2385
Provider Enumeration Date:
12/13/2012

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
MOVINSKY
Authorized Official First Name:
WILLIAM
Authorized Official Middle Name:
EDGAR
Authorized Official Title or Position:
PSYCHIATRIC TECHNICIAN
Authorized Official Telephone Number:
559-361-9595

Provider Taxonomy Codes

  • Taxonomy code: 323P00000X , with the licence number:  PT 36244 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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