Basic Information
| Provider Information | |||||||||
| NPI: | 1225432370 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | NAPA COUNTY HEALTH AND HUMAN SERVICES | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
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| OtherOrganizationName: | CLINIC OLE CALISTOGA - NAPA COUNTY ALCOHOL AND DRUG SERVICES | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2261 ELM ST | ||||||||
| Address2: | HHSA - FISCAL | ||||||||
| City: | NAPA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945593721 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7072534662 | ||||||||
| FaxNumber: | 7072534766 | ||||||||
| Practice Location | |||||||||
| Address1: | 911 WASHINGTON ST | ||||||||
| Address2: | |||||||||
| City: | CALISTOGA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945151433 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7072534662 | ||||||||
| FaxNumber: | 7072534766 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/17/2014 | ||||||||
| LastUpdateDate: | 10/17/2014 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | HIMES | ||||||||
| AuthorizedOfficialFirstName: | HOWARD | ||||||||
| AuthorizedOfficialMiddleName: | K. | ||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 7072534279 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | NAPA COUNTY | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | CA | Y | Agencies | Community/Behavioral Health |
ID Information
| ID | Type | State | Issuer | Description | 2840028 | 05 | CA | MEDICAID |