=====================================================
General NPI Number Information
=====================================================
NPI Number | 1215147285
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | YUBA COUNTY PROBATION DEPARTMENT
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/22/2007
-----------------------------------------------------
Last Update Date | 11/15/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 209 6TH STREET
-----------------------------------------------------
City | MARYSVILLE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95901
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 530-741-6275
-----------------------------------------------------
Fax | 530-749-7913
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 209 6TH STREET
-----------------------------------------------------
City | MARYSVILLE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95901
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 530-741-6275
-----------------------------------------------------
Fax | 530-749-7913
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PROGRAM MANAGER
-----------------------------------------------------
Name | MR. JASON MICHAEL ROPER
-----------------------------------------------------
Credential | MFC46889
-----------------------------------------------------
Telephone | 530-741-6275
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251B00000X
-----------------------------------------------------
Taxonomy Name | Case Management Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------