Basic Information
| Provider Information | |||||||||
| NPI: | 1447390265 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SCHOOL HEALTH CLINICS OF SANTA CLARA COUNTY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6840 VIA DEL ORO | ||||||||
| Address2: | STE# 210 | ||||||||
| City: | SAN JOSE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 95119 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4082842280 | ||||||||
| FaxNumber: | 4087540450 | ||||||||
| Practice Location | |||||||||
| Address1: | 1149 E JULIAN ST | ||||||||
| Address2: | BUILDING H. | ||||||||
| City: | SAN JOSE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 951161005 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4085356001 | ||||||||
| FaxNumber: | 4085352348 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/08/2007 | ||||||||
| LastUpdateDate: | 02/16/2022 | ||||||||
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| AuthorizedOfficialLastName: | KELINHEINZ | ||||||||
| AuthorizedOfficialFirstName: | STEPHANIE | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 4082842288 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | NP | ||||||||
| NPICertificationDate: | 02/16/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 171M00000X | N | 193200000X MULTI-SPECIALTY GROUP | Other Service Providers | Case Manager/Care Coordinator | 251X00000X | N | Agencies | Supports Brokerage | 261QH0100X | 070000689 | CA | N | Ambulatory Health Care Facilities | Clinic/Center | Health Service | 261QF0400X | Y | Ambulatory Health Care Facilities | Clinic/Center | Federally Qualified Health Center (FQHC) |
ID Information
| ID | Type | State | Issuer | Description | FHC71018F | 01 | CA | MEDI-CAL ID | OTHER | HAP70689G | 01 | CA | MEDI-CAL | OTHER |