Healthcare Provider Details

I. General information

NPI: 1588427595
Provider Name (Legal Business Name): COUNTY OF SONOMA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2024
Last Update Date: 03/14/2024
Certification Date: 03/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 CHILDRENS CIR
SANTA ROSA CA
95409-6558
US

IV. Provider business mailing address

1450 NEOTOMAS AVE STE 200
SANTA ROSA CA
95405-7574
US

V. Phone/Fax

Practice location:
  • Phone: 707-565-6350
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: RUBY ZHANG
Title or Position: FISCAL ANALYST
Credential:
Phone: 707-565-7846