1467523829 NPI number — COUNTY OF SACRAMENTO

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 1467523829 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:
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:
1467523829
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:
7001A EAST PKWY
Provider Second Line Business Mailing Address:
SUITE 600
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:
916-875-5881
Provider Business Mailing Address Fax Number:
916-875-5888

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1040 Q ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RIO LINDA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95673-1532
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-992-8882
Provider Business Practice Location Address Fax Number:
916-992-1590
Provider Enumeration Date:
11/10/2006

Additional Information

Authorized Official

Authorized Official Last Name:
WALTON
Authorized Official First Name:
BERNICE
Authorized Official Middle Name:
Authorized Official Title or Position:
DIVISION CHIEF
Authorized Official Telephone Number:
916-875-6086

Provider Taxonomy Codes

  • Taxonomy code: 261QR0401X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: CCS00024F , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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