Provider Demographics
NPI:1669802518
Name:COUNTY OF SONOMA
Entity type:Organization
Organization Name:COUNTY OF SONOMA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIVISION DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:
Authorized Official - Last Name:KALJIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:707-565-5900
Mailing Address - Street 1:3725 WESTWIND BLVD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95403-9081
Mailing Address - Country:US
Mailing Address - Phone:707-565-5900
Mailing Address - Fax:
Practice Address - Street 1:3725 WESTWIND BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95403-9081
Practice Address - Country:US
Practice Address - Phone:707-565-5900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-13
Last Update Date:2013-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAMSS00011FMedicaid