=====================================================
General NPI Number Information
=====================================================
NPI Number | 1780543967
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NAMI EL DORADO COUNTY WESTERN SLOPE AND SOUTH LAKE TAHOE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/21/2026
-----------------------------------------------------
Last Update Date | 01/21/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 471 PIERROZ RD
-----------------------------------------------------
City | PLACERVILLE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95667-4043
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 530-306-4101
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 471 PIERROZ RD
-----------------------------------------------------
City | PLACERVILLE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95667-4043
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 530-306-4101
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | TREASURER
-----------------------------------------------------
Name | ROBERT ALLEN LANDRY
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 916-606-0999
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QR0400X
-----------------------------------------------------
Taxonomy Name | Rehabilitation Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------