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General NPI Number Information
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NPI Number | 1346564465
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Entity Type | Organization
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Legal Business Name | COUNTY OF CALAVERAS
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Dates
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Enumeration Date | 03/18/2010
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Last Update Date | 11/04/2019
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Provider Practice Location Address
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Address Line | 373 W ST CHARLES STREET SUITE E
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City | SAN ANDREAS
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State | CA
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Zip | 95249-9713
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Country | US
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Telephone | 209-754-6555
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Fax |
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Provider Business Mailing Address
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Address Line | 891 MOUNTAIN RANCH RD
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City | SAN ANDREAS
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State | CA
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Zip | 95249-9713
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Country | US
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Telephone | 209-754-6555
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATIVE ASSISTANT
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Name | STACEY MEILY
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Credential |
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Telephone | 209-754-6516
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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