=====================================================
General NPI Number Information
=====================================================
NPI Number | 1598807190
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | COMMUNITY ACTION PARTNERSHIP OF SONOMA COUNTY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/12/2007
-----------------------------------------------------
Last Update Date | 09/02/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1260 N DUTTON AVE STE 220
-----------------------------------------------------
City | SANTA ROSA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95401-4686
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 707-544-6911
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2250 NORTHPOINT PKWY
-----------------------------------------------------
City | SANTA ROSA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95407-7398
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 707-544-6911
-----------------------------------------------------
Fax | 707-526-2918
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | AGENCY GRANT MANAGER
-----------------------------------------------------
Name | NATHAN SMITH
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 707-544-6911
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QC1500X
-----------------------------------------------------
Taxonomy Name | Community Health Clinic/Center
-----------------------------------------------------
License Number | 110000314
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------