Provider Demographics
NPI:1720505779
Name:COUNTY OF EL DORADO
Entity Type:Organization
Organization Name:COUNTY OF EL DORADO
Other - Org Name:ALCOHOL AND DRUG PROGRAM-CCC PROGRAM
Other - Org Type:Other Name
Authorized Official - Title/Position:SUDS PROGRAM ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SALINA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:DRENNAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:530-621-6207
Mailing Address - Street 1:768 PLEASANT VALLEY RD STE 201
Mailing Address - Street 2:
Mailing Address - City:DIAMOND SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:95619-9260
Mailing Address - Country:US
Mailing Address - Phone:530-621-6146
Mailing Address - Fax:530-295-2596
Practice Address - Street 1:3974 DUROCK RD STE 205
Practice Address - Street 2:
Practice Address - City:SHINGLE SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:95682-8568
Practice Address - Country:US
Practice Address - Phone:530-621-6659
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-29
Last Update Date:2018-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health