Provider Demographics
NPI:1609059724
Name:COUNTY OF TUOLUMNE
Entity Type:Organization
Organization Name:COUNTY OF TUOLUMNE
Other - Org Name:TARGETED CASE MANAGEMENT
Other - Org Type:Other Name
Authorized Official - Title/Position:HUMAN SERVICES AGENCY DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ANN
Authorized Official - Middle Name:
Authorized Official - Last Name:CONNOLLY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:209-533-5719
Mailing Address - Street 1:20111 CEDAR RD N
Mailing Address - Street 2:
Mailing Address - City:SONORA
Mailing Address - State:CA
Mailing Address - Zip Code:95370-5939
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:20111 CEDAR RD N
Practice Address - Street 2:
Practice Address - City:SONORA
Practice Address - State:CA
Practice Address - Zip Code:95370-5939
Practice Address - Country:US
Practice Address - Phone:209-533-7419
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-12
Last Update Date:2014-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAEXE70018FMedicaid