Organization
JAIL PSYCH SERVICES - RCCC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. PAUL E HENDRICKS RN (CLINICAL DIRECTOR)
(916) 874-5222
Entity
Organization
Contact information
Practice address
12450 BRUCEVILLE RD, ELK GROVE, CA 95757-9784
(916) 874-5222
(916) 874-8183
Mailing address
12450 BRUCEVILLE RD, ELK GROVE, CA 95757-9784
(916) 874-5222
(916) 874-8183
Taxonomy
Speciality
Code
Description
License number
State
261QP2400X
Prison Health Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
8413
COUNTY MENTAL HEALTH #
CA
Enumeration date
10/19/2006
Last updated
08/22/2020
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