1760685648 NPI number — COUNTY OF SACRAMENTO

Table of content: (NPI 1760685648)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760685648 NPI number — COUNTY OF SACRAMENTO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COUNTY OF SACRAMENTO
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:
STOCKTON RETRO - LINX
Provider Other Organization Name Type Code:
5
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:
1760685648
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:
7001 EAST PKWY # A
Provider Second Line Business Mailing Address:
SUITE 400
Provider Business Mailing Address City Name:
SACRAMENTO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95823-2501
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
916-875-4948
Provider Business Mailing Address Fax Number:
916-875-6970

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2188 STOCKTON BLVD
Provider Second Line Business Practice Location Address:
SUITE 1
Provider Business Practice Location Address City Name:
SACRAMENTO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95817-1337
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-875-1000
Provider Business Practice Location Address Fax Number:
916-875-1002
Provider Enumeration Date:
06/07/2007

Additional Information

Authorized Official

Authorized Official Last Name:
EDWARDS - BUCKLEY
Authorized Official First Name:
ANNE
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
916-875-9904

Provider Taxonomy Codes

  • Taxonomy code: 261QM0850X ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 261QM0855X ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

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

  • Identifier: 34CY , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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