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3350 Country Club Dr Unit 103 Cameron Park CA 95682-8657 | |
| (530) 622-5551 | |
| (530) 622-5800 |
| Full Name | |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 3350 Country Club Dr, Cameron Park, California |
| Authorized Official Name and Position | Mary Jo Young (ASSOC DIRECTOR, ADMIN SERVICES) |
| Authorized Official Contact | 5306225551 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
6765 Green Valley Road Placerville CA 95667 Ph: (530) 622-5551 | 3350 Country Club Dr Unit 103 Cameron Park CA 95682-8657 Ph: (530) 622-5551 |
| NPI Number | 1104020130 |
|---|---|
| Provider Enumeration Date | 06/13/2007 |
| Last Update Date | 07/22/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1104020130 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | 090005AN (California) | Primary |
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