Organization
DEPARTMENT OF HEALTH SERVICES
Active
Other names
DMH Integrated Services for Homeless Adults
Organization subpart
No
Provider details
NPI number
Authorized official
DIANA STORNETTA (COMPLIANCE AUDITOR ACCOUNTANT III)
(707) 565-4782
Entity
Organization
Contact information
Practice address
415 HUMBOLDT ST, SANTA ROSA, CA 95404-4214
(707) 565-4850
Mailing address
415 HUMBOLDT ST, SANTA ROSA, CA 95404-4214
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
49AN
PROVIDER NUMBER
CA
Enumeration date
05/15/2007
Last updated
08/22/2020
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