MEDICARE: SANTA CRUZ COUNTY CCS

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	261QP2000X	Physical Therapy 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	:	1629284609
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SANTA CRUZ COUNTY CCS

Provider Business Mailing Address
First Line	:	1080 EMELINE AVE
Second Line	:
City	:	SANTA CRUZ
State	:	CA
Zip	:	95060-1966
Country	:	US
Telephone Number	:	831-622-8400
Fax Number	:	831-761-6167

Provider Business Practice Location Address
First Line	:	140 HERMAN AVE
Second Line	:
City	:	WATSONVILLE
State	:	CA
Zip	:	95076-2920
Country	:	US
Telephone Number	:	831-688-8400
Fax Number	:	831-722-1114

Authorized Official
Title or Position	:	SENIOR PROGRAM MANAGER
Name	:	MR. CHRIS DYBDAHL
Credential	:
Telephone Number	:	831-763-8914

Provider Enumeration Date	:	05/15/2007
Last Update Date	:	08/22/2020

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Directions to “SANTA CRUZ COUNTY CCS ” Practice Location

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