# TUOLUMNE COUNTY CCS - SOULSBYVILLE MTU

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1457485617
- **Authorized official:** KATHY AMOS (DIRECTOR OF PUBLIC HEALTH NURSING)
- **Authorized official phone:** (209) 533-7403

## Contact information

- **Practice address:** 20300 SOULSBYVILLE RD, SOULSBYVILLE, CA 95372-9738
- **Practice address phone:** (209) 532-5198
- **Mailing address:** 2 S GREEN ST, SONORA, CA 95370-4618

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QR0400X | Rehabilitation Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 03/16/2007
- **Last updated:** 08/22/2020