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6767 Green Valley Rd Placerville CA 95667-8984 | |
| (530) 622-5551 | |
| (530) 622-5800 |
| Full Name | |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 6767 Green Valley Rd, Placerville, California |
| Authorized Official Name and Position | Mary Jo Young (ASSOCIATE 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 Rd Placerville CA 95667-8984 Ph: (530) 622-5551 | 6767 Green Valley Rd Placerville CA 95667-8984 Ph: (530) 622-5551 |
| NPI Number | 1962810945 |
|---|---|
| Provider Enumeration Date | 07/23/2014 |
| Last Update Date | 07/23/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1962810945 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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