Healthcare Provider Details

I. General information

NPI: 1326098161
Provider Name (Legal Business Name): DEPARTMENT OF STATE HOSPITALS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2006
Last Update Date: 08/24/2021
Certification Date: 08/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 NAPA VALLEJO HWY
NAPA CA
94558-6234
US

IV. Provider business mailing address

1215 O STREET, MS-3 DEPARTMENT OF STATE HOSPITALS - PCRS
SACRAMENTO CA
95814
US

V. Phone/Fax

Practice location:
  • Phone: 707-253-5000
  • Fax: 707-253-5513
Mailing address:
  • Phone: 916-651-8906
  • Fax: 916-651-8908

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number150000492
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code310500000X
TaxonomyMental Illness Intermediate Care Facility
License Number150000492
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number150000492
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number150000492
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number150000492
License Number StateCA
# 6
Primary TaxonomyY
Taxonomy Code283Q00000X
TaxonomyPsychiatric Hospital
License Number
License Number State

VIII. Authorized Official

Name: GEORGE MAYNARD
Title or Position: ADMINISTRATIVE DEPUTY DIRECTOR
Credential:
Phone: 916-651-3238