Healthcare Provider Details

I. General information

NPI: 1851418495
Provider Name (Legal Business Name): PLACER COUNTY MENTAL HEALTH SECRET RAVINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

645 KENTUCKY GREENS WY
NEWCASTLE CA
95658
US

IV. Provider business mailing address

645 KENTUCKY GREENS WY
NEWCASTLE CA
95658
US

V. Phone/Fax

Practice location:
  • Phone: 916-415-4425
  • Fax:
Mailing address:
  • Phone: 916-415-4425
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MAUREEN F BAUMAN
Title or Position: DIRECTOR OF ADULT SYSTEM OF CARE
Credential:
Phone: 530-889-7256