MEDICARE: FACE TO FACE, SONOMA COUNTY AIDS NETWORK

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	251B00000X	Case Management Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	AYD000170	OTHER	CA	PROVIDER NUMBER

General Provider Information

NPI Number	:	1881724706
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FACE TO FACE, SONOMA COUNTY AIDS NETWORK

Provider Business Mailing Address
First Line	:	873 2ND ST
Second Line	:
City	:	SANTA ROSA
State	:	CA
Zip	:	95404-4621
Country	:	US
Telephone Number	:	707-544-1581
Fax Number	:	707-544-1586

Provider Business Practice Location Address
First Line	:	873 2ND ST
Second Line	:
City	:	SANTA ROSA
State	:	CA
Zip	:	95404-4621
Country	:	US
Telephone Number	:	707-544-1581
Fax Number	:	707-544-1586

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MR. RICK DEAN
Credential	:
Telephone Number	:	707-544-1581

Provider Enumeration Date	:	03/07/2007
Last Update Date	:	08/22/2020

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