Provider Demographics
NPI:1235803941
Name:SCHOOL HEALTH CLINICS OF SANTA CLARA COUNTY
Entity Type:Organization
Organization Name:SCHOOL HEALTH CLINICS OF SANTA CLARA COUNTY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO/CFO
Authorized Official - Prefix:
Authorized Official - First Name:JOCELYN
Authorized Official - Middle Name:
Authorized Official - Last Name:HART
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:408-284-2289
Mailing Address - Street 1:6840 VIA DEL ORO STE 210
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95119-1372
Mailing Address - Country:US
Mailing Address - Phone:408-284-2280
Mailing Address - Fax:408-754-0450
Practice Address - Street 1:645 WOOL CREEK DR
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95112-2617
Practice Address - Country:US
Practice Address - Phone:408-283-6051
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-05
Last Update Date:2021-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAFHC70692GOtherMEDI-CAL ID
CAHAP70692GMedicaid