Provider Demographics
NPI:1912041922
Name:COUNTY OF SANTA CLARA
Entity Type:Organization
Organization Name:COUNTY OF SANTA CLARA
Other - Org Name:DEPARTMENT OF ALCOHOL AND DRUG SERVICES-CENTRAL VALLEY CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DEPARTMENT DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:GARNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:408-792-5680
Mailing Address - Street 1:976 LENZEN AVE
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95126-2737
Mailing Address - Country:US
Mailing Address - Phone:408-792-5680
Mailing Address - Fax:408-947-8702
Practice Address - Street 1:2425 ENBORG LN
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128-2648
Practice Address - Country:US
Practice Address - Phone:408-885-5400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered251S00000XAgenciesCommunity/Behavioral Health
Not Answered261QM2800XAmbulatory Health Care FacilitiesClinic/CenterMethadone
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA434397OtherSTATE PROVIDER NUMBER
CA4397OtherDRUG MEDI-CAL NUMBER