Healthcare Provider Details

I. General information

NPI: 1841344181
Provider Name (Legal Business Name): DEPARTMENT OF HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1430 NEOTOMAS AVE
SANTA ROSA CA
95405-7575
US

IV. Provider business mailing address

1430 NEOTOMAS AVE
SANTA ROSA CA
95405-7575
US

V. Phone/Fax

Practice location:
  • Phone: 707-565-7450
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DIANA L. STORNETTA
Title or Position: ACCOUNTANT III COMPLIANCE
Credential:
Phone: 707-565-4782