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NPI Code Detail

MEDICARE: JAIL SERVICES

MEDICARE: JAIL SERVICES
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
1261QM0855XAdolescent and Children Mental Health Clinic/CenterCA
2261QM0850XAdult Mental Health Clinic/CenterCA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11659315430OTHERCALEGAL ENTITIY NPI#
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1629112743
Entity Type Code : Organization
Provider Name (Legal Business Name) : JAIL SERVICES
Provider Business Mailing Address
First Line : 1400 EMELINE AVE
Second Line :
City : SANTA CRUZ
State : CA
Zip : 95060-1976
Country : US
Telephone Number : 831-454-4170
Fax Number : 831-454-4663
Provider Business Practice Location Address
First Line : 259 WATER ST
Second Line :
City : SANTA CRUZ
State : CA
Zip : 95060-4009
Country : US
Telephone Number : 831-454-4170
Fax Number :
Authorized Official
Title or Position : HEALTH SERVICES AGENCY DIRECTOR
Name : RAMA KHALSA
Credential : PH.D.
Telephone Number : 831-454-4000
Provider Enumeration Date : 02/20/2007
Last Update Date : 03/04/2008

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Directions to “JAIL SERVICES ” Practice Location

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