Healthcare Provider Details

I. General information

NPI: 1770235228
Provider Name (Legal Business Name): THE SALVATION ARMY, A CALIFORNIA CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2022
Last Update Date: 02/17/2022
Certification Date: 02/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 N B ST
SACRAMENTO CA
95811-0603
US

IV. Provider business mailing address

PO BOX 340699
SACRAMENTO CA
95834-0699
US

V. Phone/Fax

Practice location:
  • Phone: 916-442-0331
  • Fax:
Mailing address:
  • Phone: 916-563-3775
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code251X00000X
TaxonomySupports Brokerage Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: RAGAN KONTES
Title or Position: BUSINESS ADMINISTRATOR
Credential:
Phone: 916-563-3775