Provider Demographics
NPI:1447509351
Name:CONTRA COSTA COUNTY
Entity type:Organization
Organization Name:CONTRA COSTA COUNTY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:COO / CFO
Authorized Official - Prefix:
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:M
Authorized Official - Last Name:GODLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:925-957-5405
Mailing Address - Street 1:50 DOUGLAS DR SUITE 391
Mailing Address - Street 2:
Mailing Address - City:MARTINEZ
Mailing Address - State:CA
Mailing Address - Zip Code:94553-4098
Mailing Address - Country:US
Mailing Address - Phone:925-957-5405
Mailing Address - Fax:
Practice Address - Street 1:391 TAYLOR BLVD STE 100
Practice Address - Street 2:
Practice Address - City:PLEASANT HILL
Practice Address - State:CA
Practice Address - Zip Code:94523-2289
Practice Address - Country:US
Practice Address - Phone:925-608-6550
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CONTRA COSTA COUNTY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-09-06
Last Update Date:2018-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health