Organization
SOUTH COUNTY MENTAL HEALTH
Active
Parent organization
COUNTY OF SANTA CRUZ
Organization subpart
Yes
Provider details
NPI number
Legal business name
COUNTY OF SANTA CRUZ
Authorized official
JESSICA RANDOLPH (DIRECTOR OF ADMINISTRATION)
(831) 454-4000
Entity
Organization
Contact information
Practice address
1430 FREEDOM BLVD, SUITE F, WATSONVILLE, CA 95076-2780
(831) 763-8200
(831) 454-4663
Mailing address
1400 EMELINE AVE, SANTA CRUZ, CA 95060-1976
(831) 454-4971
(831) 454-4663
Taxonomy
Speciality
Code
Description
License number
State
261QM0850X
Adult Mental Health Clinic/Center
Primary
—
CA
261QM0855X
Adolescent and Children Mental Health Clinic/Center
—
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1659315430
LEGAL ENTITY NPI#
CA
05
—
4475
—
CA
01
—
FHC70044F
SANTA CRUZ COUNTY MEDI-CAL GROUP NUNMBER
CA
01
—
ZZZ91891Z
COUNTY OF SANTA CRUZ MEDICARE GROUP PTAN#
CA
Enumeration date
02/20/2007
Last updated
10/23/2019
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