MEDICARE: COUNTY OF SAN LUIS OBISPO

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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)		CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1760540322
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COUNTY OF SAN LUIS OBISPO

Provider Business Mailing Address
First Line	:	2178 JOHNSON AVE
Second Line	:
City	:	SAN LUIS OBISPO
State	:	CA
Zip	:	93401-4535
Country	:	US
Telephone Number	:	805-781-4700
Fax Number	:	805-781-1273

Provider Business Practice Location Address
First Line	:	1666 RAMONA AVE
Second Line	:
City	:	GROVER BEACH
State	:	CA
Zip	:	93433-2203
Country	:	US
Telephone Number	:	805-473-7060
Fax Number	:

Authorized Official
Title or Position	:	HEALTH AGENCY DIRECTOR
Name	:	NICHOLAS DREWS
Credential	:
Telephone Number	:	805-788-2135

Provider Enumeration Date	:	12/05/2006
Last Update Date	:	08/15/2024

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Directions to “COUNTY OF SAN LUIS OBISPO ” Practice Location

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