Provider Demographics
NPI:1346564465
Name:COUNTY OF CALAVERAS
Entity Type:Organization
Organization Name:COUNTY OF CALAVERAS
Other - Org Name:CALAVERAS COUNTY BEHAVIORAL HEALTH SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATIVE ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:STACEY
Authorized Official - Middle Name:
Authorized Official - Last Name:MEILY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:209-754-6516
Mailing Address - Street 1:891 MOUNTAIN RANCH RD
Mailing Address - Street 2:
Mailing Address - City:SAN ANDREAS
Mailing Address - State:CA
Mailing Address - Zip Code:95249-9713
Mailing Address - Country:US
Mailing Address - Phone:209-754-6555
Mailing Address - Fax:
Practice Address - Street 1:373 W ST CHARLES STREET
Practice Address - Street 2:SUITE E
Practice Address - City:SAN ANDREAS
Practice Address - State:CA
Practice Address - Zip Code:95249-9713
Practice Address - Country:US
Practice Address - Phone:209-754-6555
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-18
Last Update Date:2019-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA01087700Medicaid