Basic Information
Provider Information | |||||||||
NPI: | 1427138726 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | CONTRA COSTA COUNTY | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: | CONTRA COSTA REGIONAL MEDICAL CENTER AND HEALTH CENTERS | ||||||||
OtherOrganizationType: | 3 | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 50 DOUGLAS DRIVE | ||||||||
Address2: | HEALTH SERVICES ADMINISTRATION SUITE 391 | ||||||||
City: | MARTINEZ | ||||||||
State: | CA | ||||||||
PostalCode: | 945534098 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9259575429 | ||||||||
FaxNumber: | 9259575401 | ||||||||
Practice Location | |||||||||
Address1: | 2500 ALHAMBRA AVENUE | ||||||||
Address2: | CONTRA COSTA REGIONAL MEDICAL CENTER AND HEALTH CENTERS | ||||||||
City: | MARTINEZ | ||||||||
State: | CA | ||||||||
PostalCode: | 945533156 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9259575429 | ||||||||
FaxNumber: | 9259575401 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 10/17/2006 | ||||||||
LastUpdateDate: | 08/22/2020 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | GODLEY | ||||||||
AuthorizedOfficialFirstName: | PATRICK | ||||||||
AuthorizedOfficialMiddleName: | M | ||||||||
AuthorizedOfficialTitleorPosition: | CHIEF OPERATING OFFICER AND CFO | ||||||||
AuthorizedOfficialTelephone: | 9259575405 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: | MR. | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X |   |   | Y |   | Hospitals | General Acute Care Hospital |   |
ID Information
ID | Type | State | Issuer | Description | HSC00276 | 05 | CA |   | MEDICAID |