1740402452 NPI number — COUNTY OF SOLANO

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 1740402452 NPI number — COUNTY OF SOLANO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COUNTY OF SOLANO
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:
SCMH NORTH COUNTY 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:
1740402452
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/10/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
275 BECK AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FAIRFIELD
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94533-6804
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
707-784-8573
Provider Business Mailing Address Fax Number:
707-421-6759

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1119 E MONTE VISTA AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
VACAVILLE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95688-3009
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
707-469-4540
Provider Business Practice Location Address Fax Number:
707-469-4560
Provider Enumeration Date:
05/03/2007

Additional Information

Authorized Official

Authorized Official Last Name:
JARUMAY
Authorized Official First Name:
GIRLIE
Authorized Official Middle Name:
Authorized Official Title or Position:
H&SS CHIEF DEP ADMINISTRATION
Authorized Official Telephone Number:
707-784-8387

Provider Taxonomy Codes

  • Taxonomy code: 251B00000X , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251S00000X , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 261QM0801X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 4885 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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