Healthcare Provider Details

I. General information

NPI: 1811945132
Provider Name (Legal Business Name): COUNTY OF CALAVERAS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/05/2006
Last Update Date: 09/25/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

704 MOUNTAIN RANCH RD STE 103-105
SAN ANDREAS CA
95249-8902
US

IV. Provider business mailing address

891 MOUNTAIN RANCH RD
SAN ANDREAS CA
95249-9713
US

V. Phone/Fax

Practice location:
  • Phone: 209-754-6525
  • Fax: 209-754-6597
Mailing address:
  • Phone: 209-754-6525
  • Fax: 209-754-6597

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code251X00000X
TaxonomySupports Brokerage Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: STACEY MEILY
Title or Position: ADMINISTRATIVE ASSISTANT
Credential:
Phone: 209-754-6516