Healthcare Provider Details

I. General information

NPI: 1730989286
Provider Name (Legal Business Name): EL DORADO COUNTY PROBATION DEPARTMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2025
Last Update Date: 03/14/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1041 AL TAHOE BLVD.
SOUTH LAKE TAHOE CA
96150-4502
US

IV. Provider business mailing address

3974 DUROCK ROAD, SUITE 205
SHINGLE SPRINGS CA
95682
US

V. Phone/Fax

Practice location:
  • Phone: 530-621-7990
  • Fax:
Mailing address:
  • Phone: 530-621-5625
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: BRIAN RICHART
Title or Position: CHIEF PROBATION OFFICER
Credential:
Phone: 530-621-5625