Healthcare Provider Details

I. General information

NPI: 1851344220
Provider Name (Legal Business Name): STATE OF CALIFORNIA - DEPARTMENT OF DEVELOPMENTAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 01/24/2022
Certification Date: 01/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15000 ARNOLD DRIVE
ELDRIDGE CA
95431-1493
US

IV. Provider business mailing address

1215 O ST # MS 10-30
SACRAMENTO CA
95814-5804
US

V. Phone/Fax

Practice location:
  • Phone: 707-938-6000
  • Fax: 707-938-6940
Mailing address:
  • Phone: 916-654-3463
  • Fax: 916-653-4587

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number10000089
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License Number10000089
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number10000089
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code315P00000X
TaxonomyIntellectual Disabilities Intermediate Care Facility
License Number10000089
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number10000089
License Number StateCA
# 6
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License NumberHPE19573
License Number StateCA
# 7
Primary TaxonomyN
Taxonomy Code282E00000X
TaxonomyLong Term Care Hospital
License Number
License Number StateNULL

VIII. Authorized Official

Name: CARLA CASTANEDA
Title or Position: CHIEF DEPUTY DIRECTOR
Credential:
Phone: 916-654-2282