Basic Information
| Provider Information | |||||||||
| NPI: | 1053779926 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SACRAMENTO COUNTY MENTAL HEALTH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2150 STOCKTON BLVD | ||||||||
| Address2: | |||||||||
| City: | SACRAMENTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 958171337 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9168751000 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2150 STOCKTON BLVD | ||||||||
| Address2: | |||||||||
| City: | SACRAMENTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 958171337 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9168751000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/05/2016 | ||||||||
| LastUpdateDate: | 02/05/2016 | ||||||||
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| AuthorizedOfficialLastName: | STOFFEL | ||||||||
| AuthorizedOfficialFirstName: | DENISE | ||||||||
| AuthorizedOfficialMiddleName: | CARLEEN | ||||||||
| AuthorizedOfficialTitleorPosition: | PSYCHIATRIC NURSE | ||||||||
| AuthorizedOfficialTelephone: | 9168751000 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | SACRAMENTO COUNTY | ||||||||
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| AuthorizedOfficialCredential: | R.N. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM0850X | RN 623621 | CA | Y | Ambulatory Health Care Facilities | Clinic/Center | Adult Mental Health |
No ID Information.