Provider Demographics
NPI:1962062745
Name:CONTRA COSTA COUNTY
Entity type:Organization
Organization Name:CONTRA COSTA COUNTY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:COO AND CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:M
Authorized Official - Last Name:GODLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:925-657-5405
Mailing Address - Street 1:50 DOUGLAS DR STE 310E
Mailing Address - Street 2:
Mailing Address - City:MARTINEZ
Mailing Address - State:CA
Mailing Address - Zip Code:94553-4003
Mailing Address - Country:US
Mailing Address - Phone:925-957-5429
Mailing Address - Fax:
Practice Address - Street 1:1160 BRICKYARD COVE RD STE 111
Practice Address - Street 2:
Practice Address - City:POINT RICHMOND
Practice Address - State:CA
Practice Address - Zip Code:94801-4112
Practice Address - Country:US
Practice Address - Phone:510-215-6009
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CONTRA COSTA COUNTY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-06-14
Last Update Date:2022-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health