Basic Information
| Provider Information | |||||||||
| NPI: | 1891911830 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | ENCOMPASS COMMUNITY SERVICES | ||||||||
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| OtherOrganizationName: | SANTA CRUZ COMMUNITY COUNSELING CENTER | ||||||||
| OtherOrganizationType: | 4 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 380 ENCINAL ST | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | SANTA CRUZ | ||||||||
| State: | CA | ||||||||
| PostalCode: | 950602178 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8314691700 | ||||||||
| FaxNumber: | 8314251905 | ||||||||
| Practice Location | |||||||||
| Address1: | 161 MILES LN AND 155 MILES LN. | ||||||||
| Address2: | |||||||||
| City: | WATSONVILLE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 950763127 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8317615422 | ||||||||
| FaxNumber: | 8317613772 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/18/2007 | ||||||||
| LastUpdateDate: | 08/06/2021 | ||||||||
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| AuthorizedOfficialLastName: | MARTINEZ | ||||||||
| AuthorizedOfficialFirstName: | MONICA | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 8314691700 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 08/06/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 324500000X | 440008LN | CA | Y | Residential Treatment Facilities | Substance Abuse Rehabilitation Facility |
No ID Information.