Provider Demographics
NPI:1629131883
Name:SACRAMENTO COUNTY DEPARTMENT OF HEALTH AND HUMAN SERVICES
Entity Type:Organization
Organization Name:SACRAMENTO COUNTY DEPARTMENT OF HEALTH AND HUMAN SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF PRIMARY CARE DIVISION
Authorized Official - Prefix:DR
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDREWS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:916-875-5701
Mailing Address - Street 1:9616 MICRON AVE
Mailing Address - Street 2:SUITE 850B
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95827-2625
Mailing Address - Country:US
Mailing Address - Phone:916-875-9847
Mailing Address - Fax:916-875-9833
Practice Address - Street 1:9616 MICRON AVE
Practice Address - Street 2:SUITE 850B
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95827-2625
Practice Address - Country:US
Practice Address - Phone:916-875-9847
Practice Address - Fax:916-875-9833
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC42535302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization