Provider Demographics
NPI:1326165184
Name:PLACER COUNTY - VISTA CREEK
Entity Type:Organization
Organization Name:PLACER COUNTY - VISTA CREEK
Other - Org Name:COUNTY OF PLACER
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR OF ADULT SYSTEM OF CARE
Authorized Official - Prefix:
Authorized Official - First Name:MAUREEN
Authorized Official - Middle Name:F
Authorized Official - Last Name:BAUMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:530-889-7256
Mailing Address - Street 1:5477 EUREKA RD
Mailing Address - Street 2:
Mailing Address - City:GRANITE BAY
Mailing Address - State:CA
Mailing Address - Zip Code:95746-8808
Mailing Address - Country:US
Mailing Address - Phone:916-774-1250
Mailing Address - Fax:
Practice Address - Street 1:5477 EUREKA RD
Practice Address - Street 2:
Practice Address - City:GRANITE BAY
Practice Address - State:CA
Practice Address - Zip Code:95746-8808
Practice Address - Country:US
Practice Address - Phone:916-774-1250
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-24
Last Update Date:2010-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA3192OtherSTATE OF CA MENTAL HEALTH