Basic Information
| Provider Information | |||||||||
| NPI: | 1467608745 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | JANUS OF SANTA CRUZ | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | RESIDENTIAL TREATMENT CENTER AND SPECIAL CARE UNIT | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 200 7TH AVENUE | ||||||||
| Address2: | SUITE 150 | ||||||||
| City: | SANTA CRUZ | ||||||||
| State: | CA | ||||||||
| PostalCode: | 950624668 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8314621060 | ||||||||
| FaxNumber: | 8314624970 | ||||||||
| Practice Location | |||||||||
| Address1: | 200 7TH AVE STE 150 | ||||||||
| Address2: | |||||||||
| City: | SANTA CRUZ | ||||||||
| State: | CA | ||||||||
| PostalCode: | 950624669 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8314621060 | ||||||||
| FaxNumber: | 8314624970 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/18/2008 | ||||||||
| LastUpdateDate: | 03/08/2022 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | WILLIAMS | ||||||||
| AuthorizedOfficialFirstName: | AMBER | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | CHIEF EXECUTIVE OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 8312787906 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 02/23/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | N | Agencies | Community/Behavioral Health | 261QM0801X | N | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) | 261QM0850X | N | Ambulatory Health Care Facilities | Clinic/Center | Adult Mental Health | 261QM0855X | N | Ambulatory Health Care Facilities | Clinic/Center | Adolescent and Children Mental Health | 251S00000X | 440003EN | CA | N | Agencies | Community/Behavioral Health | 261QR0405X | 440003EN | CA | N | Ambulatory Health Care Facilities | Clinic/Center | Rehabilitation, Substance Use Disorder | 276400000X | N | Hospital Units | Rehabilitation, Substance Use Disorder Unit | 324500000X | N | Residential Treatment Facilities | Substance Abuse Rehabilitation Facility | 261QR0405X | Y | Ambulatory Health Care Facilities | Clinic/Center | Rehabilitation, Substance Use Disorder |
ID Information
| ID | Type | State | Issuer | Description | 4410 | 05 | CA | MEDICAID | 440003BN | 01 | CA | DHCS | OTHER | 440003AN | 01 | CA | DHCS | OTHER |