=====================================================
General NPI Number Information
=====================================================
NPI Number | 1679225221
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | THE SALVATION ARMY, A CALIFORNIA CORPORATION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/25/2022
-----------------------------------------------------
Last Update Date | 01/28/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3213 ORANGE GROVE AVE
-----------------------------------------------------
City | NORTH HIGHLANDS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95660-5810
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 916-678-4018
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 340699
-----------------------------------------------------
City | SACRAMENTO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95834-0699
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 916-563-3775
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | BUSINESS ADMINISTRATOR
-----------------------------------------------------
Name | RAGAN KONTES
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 916-563-3775
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171M00000X
-----------------------------------------------------
Taxonomy Name | Case Manager/Care Coordinator
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 251X00000X
-----------------------------------------------------
Taxonomy Name | Supports Brokerage Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------