Provider Demographics
NPI:1144401555
Name:PLACER COUNTY COMMUNITY HEALTH
Entity Type:Organization
Organization Name:PLACER COUNTY COMMUNITY HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADM/FISCAL OPERATIONS MGR
Authorized Official - Prefix:
Authorized Official - First Name:STAN
Authorized Official - Middle Name:
Authorized Official - Last Name:HAPAK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:530-886-1841
Mailing Address - Street 1:379 NEVADA ST
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:CA
Mailing Address - Zip Code:95603-3722
Mailing Address - Country:US
Mailing Address - Phone:530-886-1870
Mailing Address - Fax:530-886-1810
Practice Address - Street 1:11484 B AVE
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:CA
Practice Address - Zip Code:95603-2603
Practice Address - Country:US
Practice Address - Phone:530-889-7141
Practice Address - Fax:530-889-7198
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COUNTY OF PLACER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-11-14
Last Update Date:2007-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA31-06OtherSTATE OF CA - DHS TCM