Provider Demographics
NPI:1992876692
Name:COUNTY OF SACRAMENTO
Entity type:Organization
Organization Name:COUNTY OF SACRAMENTO
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SAC COUNTY PUBLIC HEALTH OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:GLENNAH
Authorized Official - Middle Name:
Authorized Official - Last Name:TROCHET
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:916-875-5881
Mailing Address - Street 1:7001A EAST PKWY
Mailing Address - Street 2:SUITE 600
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95823-2501
Mailing Address - Country:US
Mailing Address - Phone:916-875-5881
Mailing Address - Fax:916-875-5888
Practice Address - Street 1:4600 BROADWAY
Practice Address - Street 2:SUITE 2300
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95820-1527
Practice Address - Country:US
Practice Address - Phone:916-874-9231
Practice Address - Fax:916-874-9432
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COUNTY OF SACRAMENTO
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-11-13
Last Update Date:2008-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA05D0644185291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
CALAB58561FMedicaid
CA05D0644185OtherCLIA
CA1188OtherPH LABORATORY APPRV #
CAZZZ28765ZMedicare PIN