1326165960 NPI number — COUNTY OF PLACER

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 1326165960 NPI number — COUNTY OF PLACER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COUNTY OF PLACER
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:
6
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:
1326165960
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/28/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11716 ENTERPRISE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AUBURN
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95603-3732
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
530-889-6700
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11716 ENTERPRISE DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AUBURN
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95603
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-889-6700
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/26/2007

Additional Information

Authorized Official

Authorized Official Last Name:
ELLIS
Authorized Official First Name:
AMY
Authorized Official Middle Name:
R
Authorized Official Title or Position:
DIRECTOR OF ADULT SYSTEM OF CARE
Authorized Official Telephone Number:
530-889-7256

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: 3187 . This is a "STATE OF CA MENTAL HEALTH" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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