Provider Demographics
NPI:1598802134
Name:HUMBOLDT COUNTY PROBATION DEPARTMENT
Entity Type:Organization
Organization Name:HUMBOLDT COUNTY PROBATION DEPARTMENT
Other - Org Name:PROBATION SYSTEM OF CARE
Other - Org Type:Other Name
Authorized Official - Title/Position:CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:RASINES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:707-268-3308
Mailing Address - Street 1:2002 HARRISON AVE
Mailing Address - Street 2:
Mailing Address - City:EUREKA
Mailing Address - State:CA
Mailing Address - Zip Code:95501-3212
Mailing Address - Country:US
Mailing Address - Phone:707-268-3308
Mailing Address - Fax:707-443-7139
Practice Address - Street 1:1105 6TH ST
Practice Address - Street 2:
Practice Address - City:EUREKA
Practice Address - State:CA
Practice Address - Zip Code:95501-1162
Practice Address - Country:US
Practice Address - Phone:707-445-7552
Practice Address - Fax:707-445-7548
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS17461251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1267OtherMEDI-CAL PROVIDER NUMBER