Healthcare Provider Details

I. General information

NPI: 1215003835
Provider Name (Legal Business Name): COUNTY OF SACRAMENTO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/27/2006
Last Update Date: 10/26/2020
Certification Date: 10/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2130 STOCKTON BLVD BUILDINGS 100, 200
SACRAMENTO CA
95817-1337
US

IV. Provider business mailing address

7001A EAST PKWY SUITE 400
SACRAMENTO CA
95823-2501
US

V. Phone/Fax

Practice location:
  • Phone: 916-875-1086
  • Fax: 916-874-9400
Mailing address:
  • Phone: 916-875-4948
  • Fax: 916-875-6970

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: RYAN QUIST
Title or Position: DEPUTY DIRECTOR
Credential:
Phone: 916-875-9904