Basic Information
| Provider Information | |||||||||
| NPI: | 1144401555 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | PLACER COUNTY COMMUNITY HEALTH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 379 NEVADA ST | ||||||||
| Address2: | |||||||||
| City: | AUBURN | ||||||||
| State: | CA | ||||||||
| PostalCode: | 956033722 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5308861870 | ||||||||
| FaxNumber: | 5308861810 | ||||||||
| Practice Location | |||||||||
| Address1: | 11484 B AVE | ||||||||
| Address2: | |||||||||
| City: | AUBURN | ||||||||
| State: | CA | ||||||||
| PostalCode: | 956032603 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5308897141 | ||||||||
| FaxNumber: | 5308897198 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/14/2007 | ||||||||
| LastUpdateDate: | 11/14/2007 | ||||||||
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| AuthorizedOfficialLastName: | HAPAK | ||||||||
| AuthorizedOfficialFirstName: | STAN | ||||||||
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| AuthorizedOfficialTitleorPosition: | ADM/FISCAL OPERATIONS MGR | ||||||||
| AuthorizedOfficialTelephone: | 5308861841 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | COUNTY OF PLACER | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251K00000X | Y | Agencies | Public Health or Welfare |
ID Information
| ID | Type | State | Issuer | Description | 31-06 | 01 | CA | STATE OF CA - DHS TCM | OTHER |