MEDICARE: SANTA CRUZ COMMUNITY HEALTH CENTERS

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	261QM0855X	Adolescent and Children Mental Health Clinic/Center
2	261QF0400X	Federally Qualified Health Center (FQHC)

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	:	1942997796
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SANTA CRUZ COMMUNITY HEALTH CENTERS

Provider Business Mailing Address
First Line	:	PO BOX 542
Second Line	:
City	:	SANTA CRUZ
State	:	CA
Zip	:	95061-0542
Country	:	US
Telephone Number	:	831-427-3500
Fax Number	:	831-426-3286

Provider Business Practice Location Address
First Line	:	966 BOSTWICK LN
Second Line	:
City	:	SANTA CRUZ
State	:	CA
Zip	:	95062-1743
Country	:	US
Telephone Number	:	831-427-3500
Fax Number	:	831-426-3286

Authorized Official
Title or Position	:	REVENUE CYCLE DIRECTOR
Name	:	RUTH JASSO
Credential	:
Telephone Number	:	831-427-3500

Provider Enumeration Date	:	04/21/2023
Last Update Date	:	04/21/2023

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