Healthcare Provider Details

I. General information

NPI: 1730213794
Provider Name (Legal Business Name): JANUS OF SANTA CRUZ
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2007
Last Update Date: 03/08/2022
Certification Date: 02/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000A & 1010C EMELINE AVE
SANTA CRUZ CA
95060
US

IV. Provider business mailing address

200 7TH AVENUE SUITE 150
SANTA CRUZ CA
95062-4668
US

V. Phone/Fax

Practice location:
  • Phone: 831-425-0112
  • Fax: 831-425-1847
Mailing address:
  • Phone: 831-462-1060
  • Fax: 831-462-4970

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 Number4405
License Number StateCA

VIII. Authorized Official

Name: AMBER WILLIAMS
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 831-278-7906