Provider Demographics
NPI:1427597228
Name:NAPA STATE HOSPITALS
Entity Type:Organization
Organization Name:NAPA STATE HOSPITALS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL SOCIAL WORKER
Authorized Official - Prefix:MS
Authorized Official - First Name:RENEE
Authorized Official - Middle Name:TIVONI
Authorized Official - Last Name:MACK
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:707-225-3996
Mailing Address - Street 1:424 STATEN AVE
Mailing Address - Street 2:304
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94610-4961
Mailing Address - Country:US
Mailing Address - Phone:805-953-4221
Mailing Address - Fax:
Practice Address - Street 1:2100 NAPA VALLEJO HWY
Practice Address - Street 2:
Practice Address - City:NAPA
Practice Address - State:CA
Practice Address - Zip Code:94558-6234
Practice Address - Country:US
Practice Address - Phone:707-253-5000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-14
Last Update Date:2017-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA73152283Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital