Healthcare Provider Details

I. General information

NPI: 1841089828
Provider Name (Legal Business Name): COUNTY OF CALAVERAS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/05/2025
Last Update Date: 09/25/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23 E. ST. CHARLES STREET
SAN ANDREAS CA
95249
US

IV. Provider business mailing address

891 MOUNTAIN RANCH RD
SAN ANDREAS CA
95249-9713
US

V. Phone/Fax

Practice location:
  • Phone: 209-754-6466
  • Fax:
Mailing address:
  • Phone: 209-754-6516
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: STACEY MEILY
Title or Position: HHSA PROGRAM MANAGER
Credential:
Phone: 209-754-6516