Provider Demographics
NPI:1598847519
Name:JAIL PSYCH SERVICES - RCCC
Entity Type:Organization
Organization Name:JAIL PSYCH SERVICES - RCCC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:E
Authorized Official - Last Name:HENDRICKS
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:916-874-5222
Mailing Address - Street 1:12450 BRUCEVILLE RD
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95757-9784
Mailing Address - Country:US
Mailing Address - Phone:916-874-5222
Mailing Address - Fax:916-874-8183
Practice Address - Street 1:12450 BRUCEVILLE RD
Practice Address - Street 2:
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95757-9784
Practice Address - Country:US
Practice Address - Phone:916-874-5222
Practice Address - Fax:916-874-8183
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2400XAmbulatory Health Care FacilitiesClinic/CenterPrison Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA8413OtherCOUNTY MENTAL HEALTH #