Provider Demographics
NPI:1376696021
Name:NEVADA COUNTY CCS
Entity Type:Organization
Organization Name:NEVADA COUNTY CCS
Other - Org Name:CHAMPION MINE SCHOOL MTU
Other - Org Type:Other Name
Authorized Official - Title/Position:CMS COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:ALICE
Authorized Official - Middle Name:
Authorized Official - Last Name:LITTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:530-265-1450
Mailing Address - Street 1:500 CROWN POINT CIR
Mailing Address - Street 2:SUITE 110
Mailing Address - City:GRASS VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95945-9514
Mailing Address - Country:US
Mailing Address - Phone:530-265-1450
Mailing Address - Fax:530-271-0841
Practice Address - Street 1:400 HOOVER LN
Practice Address - Street 2:
Practice Address - City:NEVADA CITY
Practice Address - State:CA
Practice Address - Zip Code:95959-2944
Practice Address - Country:US
Practice Address - Phone:530-265-0618
Practice Address - Fax:530-265-0524
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACCS00002FMedicaid