Provider Demographics
NPI:1497078273
Name:ENCOMPASS COMMUNITY SERVICES
Entity Type:Organization
Organization Name:ENCOMPASS COMMUNITY SERVICES
Other - Org Name:EL DORADO IOP
Other - Org Type:Other Name
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MS
Authorized Official - First Name:KATHRYN
Authorized Official - Middle Name:
Authorized Official - Last Name:MINTZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:831-469-1700
Mailing Address - Street 1:542 OCEAN ST STE K
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95060-6622
Mailing Address - Country:US
Mailing Address - Phone:831-459-0444
Mailing Address - Fax:831-459-0665
Practice Address - Street 1:947 EL DORADO AVE
Practice Address - Street 2:
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95062-2863
Practice Address - Country:US
Practice Address - Phone:831-479-9494
Practice Address - Fax:831-479-9549
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ENCOMPASS COMMUNITY SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-03-08
Last Update Date:2016-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA445200358251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health