MEDICARE: COUNTY OF SACRAMENTO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0855X	Adolescent and Children Mental Health Clinic/Center
2	261QM0850X	Adult Mental Health Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1356417976
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COUNTY OF SACRAMENTO

Provider Business Mailing Address
First Line	:	7001A EAST PKWY
Second Line	:	SUITE 400
City	:	SACRAMENTO
State	:	CA
Zip	:	95823-2501
Country	:	US
Telephone Number	:	916-875-4948
Fax Number	:	916-875-6970

Provider Business Practice Location Address
First Line	:	7100 BOWLING GREEN DRIVE
Second Line	:	SUITE 500
City	:	SACRAMENTO
State	:	CA
Zip	:	95823
Country	:	US
Telephone Number	:	916-875-4613
Fax Number	:	916-875-4605

Authorized Official
Title or Position	:	DEPUTY DIRECTOR
Name	:	UMA ZYKOFSKY
Credential	:
Telephone Number	:	916-875-9904

Provider Enumeration Date	:	11/27/2006
Last Update Date	:	09/25/2014

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Directions to “COUNTY OF SACRAMENTO ” Practice Location

Language	Start Address	Practice Location

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