Provider Demographics
NPI:1275795692
Name:EL DORADO COUNTY HEALTH DEPARTMENT
Entity Type:Organization
Organization Name:EL DORADO COUNTY HEALTH DEPARTMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR PUBLIC HEALTH DEPARTMENT
Authorized Official - Prefix:MS
Authorized Official - First Name:GAYLE
Authorized Official - Middle Name:
Authorized Official - Last Name:ERBE-HAMLIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:530-621-6191
Mailing Address - Street 1:931 SPRING STREET
Mailing Address - Street 2:
Mailing Address - City:PLACERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95667
Mailing Address - Country:US
Mailing Address - Phone:530-621-6100
Mailing Address - Fax:530-295-2501
Practice Address - Street 1:931 SPRING STREET
Practice Address - Street 2:
Practice Address - City:PLACERVILLE
Practice Address - State:CA
Practice Address - Zip Code:95667
Practice Address - Country:US
Practice Address - Phone:530-621-6100
Practice Address - Fax:530-295-2501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-26
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP0905XAmbulatory Health Care FacilitiesClinic/CenterPublic Health, State or Local
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAFLU11130FMedicare PIN