Healthcare Provider Details

I. General information

NPI: 1194971473
Provider Name (Legal Business Name): JANUS OF SANTA CRUZ
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2008
Last Update Date: 02/23/2022
Certification Date: 02/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

516 CHESTNUT ST.
SANTA CRUZ CA
95060-3669
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 831-423-9015
  • Fax: 831-423-9098
Mailing address:
  • Phone: 831-462-1060
  • Fax: 831-462-4970

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number440003DN
License Number StateCA

VIII. Authorized Official

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