Provider Demographics
NPI:1457478216
Name:COUNTY OF PLACER
Entity Type:Organization
Organization Name:COUNTY OF PLACER
Other - Org Name:PLACER COUNTY MENTAL HEALTH - CIRBY HILLS
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 1:101 CIRBY HILLS DR
Mailing Address - Street 2:SUITE 2
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95678-4360
Mailing Address - Country:US
Mailing Address - Phone:916-787-8800
Mailing Address - Fax:
Practice Address - Street 1:101 CIRBY HILLS DR
Practice Address - Street 2:SUITE 2
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95678
Practice Address - Country:US
Practice Address - Phone:916-787-8800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COUNTY OF PLACER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-24
Last Update Date:2022-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty
No251X00000XAgenciesSupports Brokerage
No385H00000XRespite Care FacilityRespite Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA3149OtherSTATE OF CA MENTAL HEALTH
ZZZ22189ZMedicare PIN
CA3149OtherSTATE OF CA MENTAL HEALTH