Provider Demographics
NPI:1104094770
Name:SANTA CLARA COUNTY DRUG & ALCOHOL
Entity type:Organization
Organization Name:SANTA CLARA COUNTY DRUG & ALCOHOL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COUNSELOR
Authorized Official - Prefix:MR
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:BARKER
Authorized Official - Suffix:
Authorized Official - Credentials:CADC II
Authorized Official - Phone:408-885-3406
Mailing Address - Street 1:2425 ENBORG LANE
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95128
Mailing Address - Country:US
Mailing Address - Phone:408-885-3406
Mailing Address - Fax:
Practice Address - Street 1:2425 ENBORG LANE
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128
Practice Address - Country:US
Practice Address - Phone:408-885-3406
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SANTA CLARA VALLEY HEALTH & HOPITAL SYSTEM
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-02-15
Last Update Date:2008-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA305S00000X, 302R00000X
CAN4342331305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization
No305S00000XManaged Care OrganizationsPoint of Service