Healthcare Provider Details

I. General information

NPI: 1730130071
Provider Name (Legal Business Name): STATE OF CALIFORNIA - DEPARTMENT OF DEVELOPMENTAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2006
Last Update Date: 01/06/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3500 ZANKER RD
SAN JOSE CA
95134-2201
US

IV. Provider business mailing address

PO BOX 944202 1600 9TH STREET
SACRAMENTO CA
94244-2020
US

V. Phone/Fax

Practice location:
  • Phone: 408-451-6198
  • Fax: 408-451-6167
Mailing address:
  • Phone: 916-654-2431
  • Fax: 916-654-3186

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number160000519
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number160000519
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License Number160000519
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number160000519
License Number StateCA
# 5
Primary TaxonomyY
Taxonomy Code315P00000X
TaxonomyIntellectual Disabilities Intermediate Care Facility
License Number160000519
License Number StateCA

VIII. Authorized Official

Name: MS. KATHY KINSER
Title or Position: DEPUTY DIRECTOR
Credential:
Phone: 916-654-1963