Organization
TUOLUMNE COUNTY CCS - SOULSBYVILLE MTU
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KATHY AMOS (DIRECTOR OF PUBLIC HEALTH NURSING)
(209) 533-7403
Entity
Organization
Contact information
Practice address
20300 SOULSBYVILLE RD, SOULSBYVILLE, CA 95372-9738
(209) 532-5198
Mailing address
2 S GREEN ST, SONORA, CA 95370-4618
Taxonomy
Speciality
Code
Description
License number
State
261QR0400X
Rehabilitation Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
CCS00120F
—
CA
Enumeration date
03/16/2007
Last updated
08/22/2020
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