1467608745 NPI number — JANUS OF SANTA CRUZ

Table of content: (NPI 1467608745)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467608745 NPI number — JANUS OF SANTA CRUZ

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JANUS OF SANTA CRUZ
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:
RESIDENTIAL TREATMENT CENTER AND SPECIAL CARE UNIT
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:
1467608745
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/08/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
200 7TH AVENUE
Provider Second Line Business Mailing Address:
SUITE 150
Provider Business Mailing Address City Name:
SANTA CRUZ
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95062-4668
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
831-462-1060
Provider Business Mailing Address Fax Number:
831-462-4970

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
200 7TH AVE STE 150
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SANTA CRUZ
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95062-4669
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
831-462-1060
Provider Business Practice Location Address Fax Number:
831-462-4970
Provider Enumeration Date:
08/18/2008

Additional Information

Authorized Official

Authorized Official Last Name:
WILLIAMS
Authorized Official First Name:
AMBER
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF EXECUTIVE OFFICER
Authorized Official Telephone Number:
831-278-7906

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X , with the licence number:  440003EN , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QM0801X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • 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: "N" .
  • Taxonomy code: 261QR0405X , with the licence number: 440003EN , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QR0405X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 276400000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 324500000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 4410 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 440003BN . This is a "DHCS" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 440003AN . This is a "DHCS" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com