Healthcare Provider Details

I. General information

NPI: 1205055886
Provider Name (Legal Business Name): COUNTY OF AMADOR
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2007
Last Update Date: 10/26/2022
Certification Date: 10/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10877 CONDUCTOR BOULEVARD SUITE 300
SUTTER CREEK CA
95685
US

IV. Provider business mailing address

10877 CONDUCTOR BLVD STE 300
SUTTER CREEK CA
95685-9688
US

V. Phone/Fax

Practice location:
  • Phone: 209-223-6412
  • Fax: 209-223-0920
Mailing address:
  • Phone: 209-223-6412
  • Fax: 209-223-0920

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MELISSA M. CRANFILL
Title or Position: DIRECTOR
Credential:
Phone: 209-223-6412