1370 In Custody Program - Mental Health Clinic in Santa Rosa, CA

1370 In Custody Program is a mental health clinic (Clinic/center - Mental Health (including Community Mental Health Center)) in Santa Rosa, California. The current practice location for 1370 In Custody Program is 2777 Ventura Ave, Santa Rosa, California. For appointments, you can reach them via phone at (707) 565-1492. The mailing address for 1370 In Custody Program is 2777 Ventura Ave, Santa Rosa, California and phone number is (707) 565-1492.

1370 In Custody Program is licensed to practice in * (Not Available) (license number ) and its NPI number is 1164820874. This medical practice does not participate in medicare program and thus may not accept your medicare insurance. You may check if they accept your insurance at (707) 565-1492.

Contact Information

1370 In Custody Program
2777 Ventura Ave
Santa Rosa
CA 95403-2226
(707) 565-1492
Not Available

Mental Health Clinic Profile

Full Name1370 In Custody Program
SpecialityClinic/center - Mental Health (including Community Mental Health Center)
Location2777 Ventura Ave, Santa Rosa, California
Authorized Official Name and PositionDiana Stornetta (SUPERVISING ACCOUNTANT)
Authorized Official Contact7075654833
Accepts Medicare InsuranceThis clinic does not participate in Medicare Program.

Mailing Address and Practice Location

Mailing AddressPractice Location Address
1370 In Custody Program
2777 Ventura Ave
Santa Rosa
CA 95403-2226

Ph: (707) 565-1492
1370 In Custody Program
2777 Ventura Ave
Santa Rosa
CA 95403-2226

Ph: (707) 565-1492

NPI Details:

NPI Number1164820874
Provider Enumeration Date12/11/2014
Last Update Date01/16/2015

Medical Identifiers

Medical identifiers for 1370 In Custody Program such as npi, medicare ID, medicare PIN, medicaid, etc.
IdentifierTypeStateIssuer
1164820874NPI-NPPES

Medical Taxonomies and Licenses

TaxonomyTypeLicense (State)Status
261QM0801XClinic/center - Mental Health (including Community Mental Health Center) (* (Not Available))Primary

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