Provider Demographics
NPI:1649601550
Name:JANUS OF SANTA CRUZ
Entity Type:Organization
Organization Name:JANUS OF SANTA CRUZ
Other - Org Name:COMMUNITY CLINIC SOUTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:AMBER
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:831-278-7906
Mailing Address - Street 1:200 7TH AVENUE
Mailing Address - Street 2:SUITE 150
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95062-4668
Mailing Address - Country:US
Mailing Address - Phone:831-462-1060
Mailing Address - Fax:831-462-4970
Practice Address - Street 1:284 PENNSYLVANIA DR STE 1&2
Practice Address - Street 2:
Practice Address - City:WATSONVILLE
Practice Address - State:CA
Practice Address - Zip Code:95076-3768
Practice Address - Country:US
Practice Address - Phone:831-319-4200
Practice Address - Fax:831-319-4204
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-02
Last Update Date:2022-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA44-06251S00000X
251S00000X, 261QM2800X
CA4405261QM2800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2800XAmbulatory Health Care FacilitiesClinic/CenterMethadone
No251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA44ABMedicaid
CA44ACMedicaid