Healthcare Provider Details

I. General information

NPI: 1174746408
Provider Name (Legal Business Name): ENCOMPASS COMMUNITY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/11/2007
Last Update Date: 09/30/2022
Certification Date: 09/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3035 PRATHER LN
SANTA CRUZ CA
95065-1801
US

IV. Provider business mailing address

380 ENCINAL ST STE 200
SANTA CRUZ CA
95060-2178
US

V. Phone/Fax

Practice location:
  • Phone: 831-226-3930
  • Fax:
Mailing address:
  • Phone: 831-469-1700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number440707898
License Number StateCA

VIII. Authorized Official

Name: MS. MONICA MARTINEZ
Title or Position: CEO
Credential:
Phone: 831-469-1700