Provider Demographics
NPI:1154593234
Name:AMADOR COMMUNITY ACTION AGENCY
Entity type:Organization
Organization Name:AMADOR COMMUNITY ACTION AGENCY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:FAMILY ADVOCATE
Authorized Official - Prefix:MISS
Authorized Official - First Name:LORI
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:LAGG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:209-533-1397
Mailing Address - Street 1:427 HIGHWAY 49
Mailing Address - Street 2:SUITE 103
Mailing Address - City:SONORA
Mailing Address - State:CA
Mailing Address - Zip Code:95370-5666
Mailing Address - Country:US
Mailing Address - Phone:209-533-1397
Mailing Address - Fax:209-533-9620
Practice Address - Street 1:147 NORTH HIGHWAY 49
Practice Address - Street 2:SUITE 103
Practice Address - City:SONORA
Practice Address - State:CA
Practice Address - Zip Code:95370
Practice Address - Country:US
Practice Address - Phone:209-533-1397
Practice Address - Fax:209-533-9620
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-28
Last Update Date:2008-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA4HIM287251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management