Provider Demographics
NPI:1265558324
Name:COUNTY OF SANTA CLARA
Entity type:Organization
Organization Name:COUNTY OF SANTA CLARA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:DANE
Authorized Official - Last Name:PENA
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:408-885-5782
Mailing Address - Street 1:828 S BASCOM AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95128-2651
Mailing Address - Country:US
Mailing Address - Phone:408-885-5770
Mailing Address - Fax:
Practice Address - Street 1:828 S BASCOM AVE
Practice Address - Street 2:SUITE 100 AND 120
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128-2651
Practice Address - Country:US
Practice Address - Phone:408-793-5959
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COUNTY OF SANTA CLARA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-21
Last Update Date:2012-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA43APOtherSDMH PROVIDER NUMBER