Provider Demographics
NPI:1952637027
Name:COUNTY OF SONOMA
Entity Type:Organization
Organization Name:COUNTY OF SONOMA
Other - Org Name:CMHC CLOVERDALE
Other - Org Type:Other Name
Authorized Official - Title/Position:DEPARTMENT ANALYST
Authorized Official - Prefix:
Authorized Official - First Name:RUBY
Authorized Official - Middle Name:
Authorized Official - Last Name:ZHANG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:707-565-7846
Mailing Address - Street 1:1360 N MCDOWELL BLVD
Mailing Address - Street 2:STE 1A
Mailing Address - City:PETALUMA
Mailing Address - State:CA
Mailing Address - Zip Code:94954-1177
Mailing Address - Country:US
Mailing Address - Phone:707-894-4715
Mailing Address - Fax:
Practice Address - Street 1:140 S CLOVERDALE BLVD
Practice Address - Street 2:
Practice Address - City:CLOVERDALE
Practice Address - State:CA
Practice Address - Zip Code:95425
Practice Address - Country:US
Practice Address - Phone:707-894-4715
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COUNTY OF SONOMA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-10-26
Last Update Date:2023-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA49FPOtherPROVIDER NUMBER