Healthcare Provider Details

I. General information

NPI: 1104094770
Provider Name (Legal Business Name): SANTA CLARA COUNTY DRUG & ALCOHOL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/15/2008
Last Update Date: 02/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2425 ENBORG LANE
SAN JOSE CA
95128
US

IV. Provider business mailing address

2425 ENBORG LANE
SAN JOSE CA
95128
US

V. Phone/Fax

Practice location:
  • Phone: 408-885-3406
  • Fax:
Mailing address:
  • Phone: 408-885-3406
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code305S00000X
TaxonomyPoint of Service
License Number
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code305S00000X
TaxonomyPoint of Service
License NumberN4342331
License Number StateCA

VIII. Authorized Official

Name: MR. FRANK WILLIAM BARKER
Title or Position: COUNSELOR
Credential: CADC II
Phone: 408-885-3406