MEDICARE: COUNTY OF SANTA CLARA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1053713958
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COUNTY OF SANTA CLARA

Provider Business Mailing Address
First Line	:	976 LENZEN AVE FL 3
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95126-2737
Country	:	US
Telephone Number	:	408-792-5680
Fax Number	:

Provider Business Practice Location Address
First Line	:	2650 SENTER RD
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95111-1121
Country	:	US
Telephone Number	:	408-283-7171
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	BRUCE COPLEY
Credential	:
Telephone Number	:	408-792-5680

Provider Enumeration Date	:	09/23/2014
Last Update Date	:	09/23/2014

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