| County Of Calaveras | |
|
704 Mountain Ranch Rd Ste 103-105 San Andreas CA 95249-8902 | |
| (209) 754-6525 | |
| (209) 754-6597 |
| Full Name | County Of Calaveras |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 704 Mountain Ranch Rd Ste 103-105, San Andreas, California |
| Authorized Official Name and Position | Stacey Meily (ADMINISTRATIVE ASSISTANT) |
| Authorized Official Contact | 2097546516 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| County Of Calaveras 891 Mountain Ranch Rd San Andreas CA 95249-9713 Ph: (209) 754-6525 | County Of Calaveras 704 Mountain Ranch Rd Ste 103-105 San Andreas CA 95249-8902 Ph: (209) 754-6525 |
| NPI Number | 1811945132 |
|---|---|
| Provider Enumeration Date | 05/05/2006 |
| Last Update Date | 09/03/2025 |
| Certification Date | 09/03/2025 |
| Medicare PECOS PAC ID | 1052318045 |
|---|---|
| Medicare Enrollment ID | O20250520004655 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1811945132 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
| Provider Name | Rebecca L Carrillo |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1003088428 PECOS PAC ID: 9234379108 Enrollment ID: I20130717000654 |
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