1598847519 NPI number — JAIL PSYCH SERVICES - RCCC

Table of content: (NPI 1598847519)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598847519 NPI number — JAIL PSYCH SERVICES - RCCC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JAIL PSYCH SERVICES - RCCC
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:
1598847519
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12450 BRUCEVILLE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ELK GROVE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95757-9784
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
916-874-5222
Provider Business Mailing Address Fax Number:
916-874-8183

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12450 BRUCEVILLE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ELK GROVE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95757-9784
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-874-5222
Provider Business Practice Location Address Fax Number:
916-874-8183
Provider Enumeration Date:
10/19/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
HENDRICKS
Authorized Official First Name:
PAUL
Authorized Official Middle Name:
E
Authorized Official Title or Position:
CLINICAL DIRECTOR
Authorized Official Telephone Number:
916-874-5222

Provider Taxonomy Codes

  • Taxonomy code: 261QP2400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 8413 . This is a "COUNTY MENTAL HEALTH #" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".