Healthcare Provider Details

I. General information

NPI: 1063159168
Provider Name (Legal Business Name): COUNTY OF SANTA CLARA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2022
Last Update Date: 05/19/2022
Certification Date: 05/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

871 ENBORG CT UNIT 400
SAN JOSE CA
95128-2645
US

IV. Provider business mailing address

828 S BASCOM AVE STE 200
SAN JOSE CA
95128-2600
US

V. Phone/Fax

Practice location:
  • Phone: 408-885-5770
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: SHERRI TERAO
Title or Position: DIRECTOR OF BHSD
Credential:
Phone: 408-885-5776