Provider Demographics
NPI:1720306939
Name:LIFE WORKS OF SONOMA COUNTY
Entity Type:Organization
Organization Name:LIFE WORKS OF SONOMA COUNTY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JILL
Authorized Official - Middle Name:W
Authorized Official - Last Name:ROYCE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:707-568-2300
Mailing Address - Street 1:1200 COLLEGE AVENUE
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95404-3908
Mailing Address - Country:US
Mailing Address - Phone:707-568-2300
Mailing Address - Fax:707-568-2304
Practice Address - Street 1:2590 PINER ROAD
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95401-4035
Practice Address - Country:US
Practice Address - Phone:707-522-3320
Practice Address - Fax:707-522-3001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-12
Last Update Date:2010-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health