Provider Demographics
NPI:1578680310
Name:COUNTY OF SANTA CRUZ
Entity Type:Organization
Organization Name:COUNTY OF SANTA CRUZ
Other - Org Name:COUNTY OF SANTA CRUZ HEALTH SERVICES AGENCY FQHC SANTA CRUZ CLINIC
Other - Org Type:Other Name
Authorized Official - Title/Position:CHIEF OF CLINICS
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:PEELER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:831-454-4764
Mailing Address - Street 1:1080 EMELINE AVE
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95060-1966
Mailing Address - Country:US
Mailing Address - Phone:831-454-4100
Mailing Address - Fax:831-454-4488
Practice Address - Street 1:1080 EMELINE AVE
Practice Address - Street 2:
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95060-1966
Practice Address - Country:US
Practice Address - Phone:831-454-4100
Practice Address - Fax:831-454-4296
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COUNTY OF SANTA CRUZ
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-26
Last Update Date:2023-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261Q00000X, 261QF0400X, 261QM0855X
CA261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAFHC70042FMedicaid
CAHAP70042FOtherSTATE - FAMILY PLANNING
CABCP70042FOtherCANCER DETECTION PROGRM
CA1659315430OtherLEGAL ENTITY NPI
CAZZZ91892ZMedicare PIN