Organization
DEPARTMENT OF HEALTH SERVICES
Active
Other names
Foster Care - Value Options
Organization subpart
No
Provider details
NPI number
Authorized official
DIANA STORNETTA (COMPLIANCE AUDITOR ACCOUNTANT III)
(707) 565-4850
Entity
Organization
Contact information
Practice address
3322 CHANATE RD, SANTA ROSA, CA 95404-1708
(707) 565-4850
Mailing address
3322 CHANATE RD, SANTA ROSA, CA 95404-1708
(707) 565-4850
Taxonomy
Speciality
Code
Description
License number
State
261QM0855X
Adolescent and Children Mental Health Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
49ZZ
FOSTER CARE PROVIDER NUMB
CA
Enumeration date
05/22/2007
Last updated
08/22/2020
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