Healthcare Provider Details

I. General information

NPI: 1770665887
Provider Name (Legal Business Name): SANTA MARIA SUPPORT SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2006
Last Update Date: 11/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 S MILLER ST SUITE 104
SANTA MARIA CA
93454-5233
US

IV. Provider business mailing address

1080 MARINA VILLAGE PKWY SUITE 100
ALAMEDA CA
94501-6427
US

V. Phone/Fax

Practice location:
  • Phone: 805-348-1850
  • Fax: 805-348-1856
Mailing address:
  • Phone: 510-337-7950
  • Fax: 510-337-7969

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: MARSHALL LANGFELD
Title or Position: VICE PRESIDENT
Credential:
Phone: 510-337-7950