Healthcare Provider Details

I. General information

NPI: 1396964946
Provider Name (Legal Business Name): COUNCIL ON AGING SERVICES FOR SENIORS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2007
Last Update Date: 04/07/2026
Certification Date: 04/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 KAWANA SPRINGS RD
SANTA ROSA CA
95404-6309
US

IV. Provider business mailing address

30 KAWANA SPRINGS RD
SANTA ROSA CA
95404-6309
US

V. Phone/Fax

Practice location:
  • Phone: 707-525-0143
  • Fax: 707-525-0143
Mailing address:
  • Phone: 707-525-0143
  • Fax: 707-525-0143

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number StateNULL
# 5
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateNULL
# 6
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number StateNULL
# 7
Primary TaxonomyN
Taxonomy Code174200000X
TaxonomyMeals Provider
License Number
License Number StateNULL

VIII. Authorized Official

Name: JAMIE ESCOUBAS
Title or Position: PRESIDENT & CEO
Credential:
Phone: 707-525-0143