Provider Demographics
NPI:1811122195
Name:TRIBAL ECONOMIC AND SOCIAL SOLUTIONS AGENCY
Entity type:Organization
Organization Name:TRIBAL ECONOMIC AND SOCIAL SOLUTIONS AGENCY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:DANA
Authorized Official - Middle Name:
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:ASW
Authorized Official - Phone:916-719-5585
Mailing Address - Street 1:4343 MARCONI AVE
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95821-4300
Mailing Address - Country:US
Mailing Address - Phone:916-485-2600
Mailing Address - Fax:
Practice Address - Street 1:4343 MARCONI AVE
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95821-4300
Practice Address - Country:US
Practice Address - Phone:916-485-2600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-15
Last Update Date:2009-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA347004341253J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253J00000XAgenciesFoster Care Agency