Provider Demographics
NPI:1962236414
Name:COUNTY OF EL DORADO
Entity type:Organization
Organization Name:COUNTY OF EL DORADO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SHERIFF-CORONER-PUBLIC ADMINISTRATO
Authorized Official - Prefix:
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:
Authorized Official - Last Name:LEIKAUF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:530-621-5655
Mailing Address - Street 1:200 INDUSTRIAL DR.
Mailing Address - Street 2:
Mailing Address - City:PLACERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95667
Mailing Address - Country:US
Mailing Address - Phone:530-621-5655
Mailing Address - Fax:
Practice Address - Street 1:300 FORNI ROAD
Practice Address - Street 2:
Practice Address - City:PLACERVILLE
Practice Address - State:CA
Practice Address - Zip Code:95667
Practice Address - Country:US
Practice Address - Phone:530-621-6000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COUNTY OF EL DORADO
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-08-28
Last Update Date:2024-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2400XAmbulatory Health Care FacilitiesClinic/CenterPrison Health