Provider Demographics
NPI:1629124037
Name:COUNTY OF SONOMA
Entity Type:Organization
Organization Name:COUNTY OF SONOMA
Other - Org Name:ADULT MEDICATION SUPPORT SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DEPARTMENT ANALYST
Authorized Official - Prefix:
Authorized Official - First Name:RUBY
Authorized Official - Middle Name:
Authorized Official - Last Name:ZHANG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:707-565-7846
Mailing Address - Street 1:2235 CHALLENGER WAY STE 107
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95407-5421
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2235 CHALLENGER WAY STE 107-108
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95407-5458
Practice Address - Country:US
Practice Address - Phone:707-565-4917
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COUNTY OF SONOMA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-01-26
Last Update Date:2023-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA49C1OtherPROVIDER NUMBER