Provider Demographics
NPI:1679225221
Name:THE SALVATION ARMY, A CALIFORNIA CORPORATION
Entity Type:Organization
Organization Name:THE SALVATION ARMY, A CALIFORNIA CORPORATION
Other - Org Name:THE SALVATION ARMY, SACRAMENTO FAMILY SERVICES
Other - Org Type:Other Name
Authorized Official - Title/Position:BUSINESS ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:RAGAN
Authorized Official - Middle Name:
Authorized Official - Last Name:KONTES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-563-3775
Mailing Address - Street 1:PO BOX 340699
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95834-0699
Mailing Address - Country:US
Mailing Address - Phone:916-563-3775
Mailing Address - Fax:
Practice Address - Street 1:3213 ORANGE GROVE AVE
Practice Address - Street 2:
Practice Address - City:NORTH HIGHLANDS
Practice Address - State:CA
Practice Address - Zip Code:95660-5810
Practice Address - Country:US
Practice Address - Phone:916-678-4018
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE SALVATION ARMY, A CALIFORNIA CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-01-25
Last Update Date:2022-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251X00000XAgenciesSupports Brokerage
No171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty