Provider Demographics
NPI:1508435983
Name:CONTRA COSTA COUNTY
Entity Type:Organization
Organization Name:CONTRA COSTA COUNTY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FISCAL MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:H
Authorized Official - Last Name:DECESARE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:925-957-5429
Mailing Address - Street 1:2500 BATES AVE STE B
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:CA
Mailing Address - Zip Code:94520-1208
Mailing Address - Country:US
Mailing Address - Phone:925-608-5200
Mailing Address - Fax:925-608-5188
Practice Address - Street 1:2500 BATES AVE STE B
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94520-1208
Practice Address - Country:US
Practice Address - Phone:925-608-5200
Practice Address - Fax:925-608-5188
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CONTRA COSTA COUNTY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-06-21
Last Update Date:2021-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1306912241Medicaid