Provider Demographics
NPI:1225730062
Name:SANTA CRUZ COMMUNITY HEALTH CENTERS
Entity Type:Organization
Organization Name:SANTA CRUZ COMMUNITY HEALTH CENTERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REVENUE CYCLE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:RUTH
Authorized Official - Middle Name:
Authorized Official - Last Name:JASSO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:831-427-3500
Mailing Address - Street 1:PO BOX 542
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95061-0542
Mailing Address - Country:US
Mailing Address - Phone:831-427-3500
Mailing Address - Fax:
Practice Address - Street 1:1916 CAPITOLA RD
Practice Address - Street 2:
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95062-3011
Practice Address - Country:US
Practice Address - Phone:831-427-3500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-17
Last Update Date:2023-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1952749541Medicaid