Healthcare Provider Details

I. General information

NPI: 1619011616
Provider Name (Legal Business Name): COUNTY OF SANTA CLARA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/16/2007
Last Update Date: 07/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

90 HIGHLAND AVE
SAN MARTIN CA
95046-9504
US

IV. Provider business mailing address

976 LENZEN AVE 3RD FLOOR
SAN JOSE CA
95126-2737
US

V. Phone/Fax

Practice location:
  • Phone: 408-686-2222
  • Fax:
Mailing address:
  • Phone: 408-792-5680
  • Fax: 408-947-8702

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM2800X
TaxonomyMethadone Clinic
License Number
License Number State

VIII. Authorized Official

Name: MR. ROBERT GARNER
Title or Position: DEPARTMENT DIRECTOR
Credential:
Phone: 408-792-5680