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
2	261QM2800X	Methadone Clinic

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	434394	OTHER	CA	STATE PROVIDER NUMBER
2	4394	OTHER	CA	DRUG MEDI-CAL NUMBER

General Provider Information

NPI Number	:	1619011616
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COUNTY OF SANTA CLARA

Provider Business Mailing Address
First Line	:	976 LENZEN AVE
Second Line	:	3RD FLOOR
City	:	SAN JOSE
State	:	CA
Zip	:	95126-2737
Country	:	US
Telephone Number	:	408-792-5680
Fax Number	:	408-947-8702

Provider Business Practice Location Address
First Line	:	90 HIGHLAND AVE
Second Line	:
City	:	SAN MARTIN
State	:	CA
Zip	:	95046-9504
Country	:	US
Telephone Number	:	408-686-2222
Fax Number	:

Authorized Official
Title or Position	:	DEPARTMENT DIRECTOR
Name	:	MR. ROBERT GARNER
Credential	:
Telephone Number	:	408-792-5680

Provider Enumeration Date	:	02/16/2007
Last Update Date	:	07/23/2010

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Directions to “COUNTY OF SANTA CLARA ” Practice Location

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