=====================================================
General NPI Number Information
=====================================================
NPI Number | 1457559924
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | COUNTY OF SANTA CRUZ
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/06/2007
-----------------------------------------------------
Last Update Date | 09/26/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1400 EMELINE AVE
-----------------------------------------------------
City | SANTA CRUZ
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95060-1976
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 831-454-4170
-----------------------------------------------------
Fax | 831-454-4663
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1400 EMELINE AVE
-----------------------------------------------------
City | SANTA CRUZ
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95060-1976
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 831-454-4170
-----------------------------------------------------
Fax | 831-454-4663
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | INTERIM DIRECTOR
-----------------------------------------------------
Name | MIMI HALL
-----------------------------------------------------
Credential | MPH
-----------------------------------------------------
Telephone | 831-454-7519
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM0850X
-----------------------------------------------------
Taxonomy Name | Adult Mental Health Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------