Provider Demographics
NPI:1659810513
Name:COUNTY OF SANTA CRUZ
Entity Type:Organization
Organization Name:COUNTY OF SANTA CRUZ
Other - Org Name:HEALTH SERVICES AGENCY-FQHC-MENTAL HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF HEALTH SERVICES AGENCY
Authorized Official - Prefix:
Authorized Official - First Name:GIANG
Authorized Official - Middle Name:
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:831-454-4000
Mailing Address - Street 1:1080 EMELINE AVE
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95060-1966
Mailing Address - Country:US
Mailing Address - Phone:831-454-4000
Mailing Address - Fax:
Practice Address - Street 1:1080 EMELINE AVE
Practice Address - Street 2:
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95060-1966
Practice Address - Country:US
Practice Address - Phone:831-454-4000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-13
Last Update Date:2017-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1659315430OtherLEGAL ENTITY NUMBER
CAZZZ91892ZOtherSANTA CRUZ COUNTY, CA MEDICARE GROUP PTAN#
CAFHC70042FOtherSANTA CRUZ COUNTY, CA MEDI-CAL GROUP ID#
CAFHC70044FOtherSANTA CRUZ COUNTY, CA MEDI-CAL GROUP ID#
CAZZZ92069ZOtherSANTA CRUZ COUNTY, CA MEDICARE GROUP PTAN#
CAZZZ91891ZOtherSANTA CRUZ COUNTY, CA MEDICARE GROUP PTAN#