Provider Demographics
NPI:1497865976
Name:COUNTY OF SANTA CLARA
Entity Type:Organization
Organization Name:COUNTY OF SANTA CLARA
Other - Org Name:SCCMHD - JUVENILE HALL MENTAL HEALTH SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:DANE
Authorized Official - Last Name:PENA
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:408-885-5782
Mailing Address - Street 1:828 SOUTH BASCOM AVENUE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95128
Mailing Address - Country:US
Mailing Address - Phone:408-885-5784
Mailing Address - Fax:408-885-5788
Practice Address - Street 1:840 GUADALUPE PKWY
Practice Address - Street 2:SUITE 238
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95110-1714
Practice Address - Country:US
Practice Address - Phone:408-299-3166
Practice Address - Fax:408-971-2651
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COUNTY OF SANTA CLARA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-30
Last Update Date:2023-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ24271ZMedicare PIN