=====================================================
General NPI Number Information
=====================================================
NPI Number | 1538385562
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ENCOMPASS COMMUNITY SERVICES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/18/2007
-----------------------------------------------------
Last Update Date | 12/30/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 125 RIGG ST AND 121 WEEKS AVE COTTAGE A AND SUITE A
-----------------------------------------------------
City | SANTA CRUZ
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95060-4203
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 831-226-3728
-----------------------------------------------------
Fax | 831-423-6657
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 380 ENCINAL ST STE 200
-----------------------------------------------------
City | SANTA CRUZ
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95060-2178
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 831-469-1700
-----------------------------------------------------
Fax | 831-425-1905
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | MONICA MARTINEZ
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 831-469-1700
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 324500000X
-----------------------------------------------------
Taxonomy Name | Substance Abuse Rehabilitation Facility
-----------------------------------------------------
License Number | 440008AN
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------