Provider Demographics
NPI:1114478583
Name:EL DORADO COUNTY COMMUNITY HEALTH C
Entity Type:Organization
Organization Name:EL DORADO COUNTY COMMUNITY HEALTH C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:JUDY
Authorized Official - Middle Name:
Authorized Official - Last Name:STEIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:530-748-2327
Mailing Address - Street 1:4212 MISSOURI FLAT RD
Mailing Address - Street 2:
Mailing Address - City:PLACERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95667-6269
Mailing Address - Country:US
Mailing Address - Phone:530-621-7700
Mailing Address - Fax:530-621-7713
Practice Address - Street 1:4212 MISSOURI FLAT RD
Practice Address - Street 2:
Practice Address - City:PLACERVILLE
Practice Address - State:CA
Practice Address - Zip Code:95667-6269
Practice Address - Country:US
Practice Address - Phone:530-621-7700
Practice Address - Fax:530-621-7713
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-20
Last Update Date:2023-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95005147261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care