NPIMap

Organization Active NPI

Santa Cruz Community Health Centers

Doing business as Shoreline Middle School

  • Adolescent and Children Mental Health Clinic/Center
  • Santa Cruz, CA
National Provider Identifier
1184352056
Registry record updated Aug 9, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adolescent and Children Mental Health Clinic/CenterTaxonomy code 261QM0855X
Legal business name
SANTA CRUZ COMMUNITY HEALTH CENTERS
Doing business as
Shoreline Middle School
Practice address
855 17TH Ave
Santa Cruz, CA 95062-4169
Phone
(831) 427-3500
Fax
(831) 426-3286
NPI assigned
Aug 9, 2022
Last updated
Aug 9, 2022By the provider in NPPES
Organization subpart
Yes
Parent organization
SANTA CRUZ COMMUNITY HEALTH CENTERSAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Aug 9, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Ruth Jasso
Title
Revenue Cycle Manager
Phone
(831) 427-3500

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X NU
Adolescent and Children Mental Health Clinic/Center 261QM0855X NU Primary

Addresses

Primary practice location

855 17TH Ave
Santa Cruz, CA 95062-4169

Mailing address

PO Box 542
Santa Cruz, CA 95061-0542
Phone (831) 427-3500

Other identifiers 1

IdentifierTypeStateIssuer
1952749541MedicaidCA

Other names 1

  • Shoreline Middle School Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
SOAP URL VPN Direct Santa Cruz Community Health Centers

National Provider Directory

National Provider Directory
Tax ID family
Santa Cruz Community Health6 organizations share this tax ID, including this one
Part of
Santa Cruz Community Health

Other organizations with this tax ID 5

Organizations that report the same tax identification number in the National Provider Directory.

Locations

855 17th Ave
Santa Cruz, CA 95062

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1660003200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1660003200000",
    "number": "1184352056",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 542",
            "city": "SANTA CRUZ",
            "state": "CA",
            "postal_code": "950610542",
            "telephone_number": "831-427-3500",
            "fax_number": "831-426-3286"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "855 17TH AVE",
            "city": "SANTA CRUZ",
            "state": "CA",
            "postal_code": "950624169",
            "telephone_number": "831-427-3500",
            "fax_number": "831-426-3286"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SANTA CRUZ COMMUNITY HEALTH CENTERS",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SANTA CRUZ COMMUNITY HEALTH CENTERS",
        "enumeration_date": "2022-08-09",
        "last_updated": "2022-08-09",
        "certification_date": "2022-08-09",
        "status": "A",
        "authorized_official_last_name": "JASSO",
        "authorized_official_first_name": "RUTH",
        "authorized_official_title_or_position": "REVENUE CYCLE MANAGER",
        "authorized_official_telephone_number": "831-427-3500"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0855X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adolescent and Children Mental Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1952749541",
            "state": "CA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "VPN",
            "affiliation": "Y",
            "endpointDescription": "Remote connection to secure server",
            "affiliationName": "Santa Cruz Community Health Centers",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "VPN",
            "address_1": "21507 E Cliff Dr",
            "city": "Santa Cruz",
            "state": "CA",
            "country_code": "US",
            "postal_code": "950624844",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Shoreline Middle School",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Santa Cruz, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 9, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.