Healthcare Provider Details

I. General information

NPI: 1750408514
Provider Name (Legal Business Name): COUNTY OF PLACER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/24/2007
Last Update Date: 04/02/2024
Certification Date: 04/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11434 B AVE SUITE 100
AUBURN CA
95603
US

IV. Provider business mailing address

11434 B AVE SUITE 100
AUBURN CA
95603
US

V. Phone/Fax

Practice location:
  • Phone: 530-889-7240
  • Fax:
Mailing address:
  • Phone: 530-889-7240
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251X00000X
TaxonomySupports Brokerage Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: AMY R ELLIS
Title or Position: DIRECTOR OF ADULT SYSTEM OF CARE
Credential:
Phone: 530-889-7256