Provider Demographics
NPI:1770709149
Name:COUNTY OF SANTA CRUZ
Entity type:Organization
Organization Name:COUNTY OF SANTA CRUZ
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF OF CLINIC SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:PEELER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:831-454-4764
Mailing Address - Street 1:1080 EMELINE AVE
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95060-1966
Mailing Address - Country:US
Mailing Address - Phone:831-454-5401
Mailing Address - Fax:831-454-4488
Practice Address - Street 1:1430 FREEDOM BLVD.
Practice Address - Street 2:
Practice Address - City:WATSONVILLE
Practice Address - State:CA
Practice Address - Zip Code:95076
Practice Address - Country:US
Practice Address - Phone:831-763-8400
Practice Address - Fax:831-763-8237
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COUNTY OF SANTA CRUZ
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-04-17
Last Update Date:2023-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA261QM0850X, 261QM0855X
261Q00000X, 261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1659315430OtherLEGAL ENTITY NPI
CAFHC70044FMedicaid
CA261QM0855XOtherTAXONOMY
CAHAP70044FOtherSTATE OF CA FOR FAMILY PL
CABCP70044FOtherCALIF. CANCER DETECTION
CA261QM0850XOtherTAXONOMY
CAFHC70044FMedicaid