Provider Demographics
NPI:1326165960
Name:COUNTY OF PLACER
Entity Type:Organization
Organization Name:COUNTY OF PLACER
Other - Org Name:PLACER COUNTY MENTAL HEALTH - ENTERPRISE
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR OF ADULT SYSTEM OF CARE
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:R
Authorized Official - Last Name:ELLIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:530-889-7256
Mailing Address - Street 1:11716 ENTERPRISE DR
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:CA
Mailing Address - Zip Code:95603-3732
Mailing Address - Country:US
Mailing Address - Phone:530-889-6700
Mailing Address - Fax:
Practice Address - Street 1:11716 ENTERPRISE DR
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:CA
Practice Address - Zip Code:95603
Practice Address - Country:US
Practice Address - Phone:530-889-6700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COUNTY OF PLACER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-26
Last Update Date:2018-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA3187OtherSTATE OF CA MENTAL HEALTH