Provider Demographics
NPI:1619447653
Name:CITY OF SANTA CLARA
Entity Type:Organization
Organization Name:CITY OF SANTA CLARA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FINANCE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BROCK
Authorized Official - Middle Name:
Authorized Official - Last Name:JACOBSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:435-673-6712
Mailing Address - Street 1:PO BOX 4415
Mailing Address - Street 2:
Mailing Address - City:CAMP VERDE
Mailing Address - State:AZ
Mailing Address - Zip Code:86322-4415
Mailing Address - Country:US
Mailing Address - Phone:435-673-6712
Mailing Address - Fax:435-628-7338
Practice Address - Street 1:2603 SANTA CLARA DR
Practice Address - Street 2:
Practice Address - City:SANTA CLARA
Practice Address - State:UT
Practice Address - Zip Code:84765-5463
Practice Address - Country:US
Practice Address - Phone:435-673-6712
Practice Address - Fax:435-628-7338
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-03
Last Update Date:2018-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance