Provider Demographics
NPI:1023231859
Name:EL DORADO COUNTY PSYCHIATRIC HEALTH FACILITY
Entity type:Organization
Organization Name:EL DORADO COUNTY PSYCHIATRIC HEALTH FACILITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT DIRECTOR HEALTH SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:CHARLES-HEATHERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:530-621-6270
Mailing Address - Street 1:935B SPRING ST
Mailing Address - Street 2:
Mailing Address - City:PLACERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95667-4543
Mailing Address - Country:US
Mailing Address - Phone:530-621-6270
Mailing Address - Fax:530-295-2580
Practice Address - Street 1:935B SPRING ST
Practice Address - Street 2:
Practice Address - City:PLACERVILLE
Practice Address - State:CA
Practice Address - Zip Code:95667-4543
Practice Address - Country:US
Practice Address - Phone:530-621-6270
Practice Address - Fax:530-295-2580
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-10
Last Update Date:2015-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1015002273R00000X, 273R00000X
CA097004267323P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273R00000XHospital UnitsPsychiatric Unit
No323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility