Provider Demographics
NPI:1720851058
Name:ASSOCIATION OF FAITH COMMUNITIES OF SANTA CRUZ COUNTY, INC.
Entity Type:Organization
Organization Name:ASSOCIATION OF FAITH COMMUNITIES OF SANTA CRUZ COUNTY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SAM
Authorized Official - Middle Name:
Authorized Official - Last Name:ALTIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:831-515-6964
Mailing Address - Street 1:532 CENTER ST
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95060-4313
Mailing Address - Country:US
Mailing Address - Phone:831-515-6964
Mailing Address - Fax:
Practice Address - Street 1:501 SOQUEL AVE STE G
Practice Address - Street 2:
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95062-2386
Practice Address - Country:US
Practice Address - Phone:831-515-6964
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-30
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty