NPIMap

Organization Active NPI

Tuolumne County CCS - Soulsbyville Mtu

  • Rehabilitation Clinic/Center
  • Soulsbyville, CA
National Provider Identifier
1457485617
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rehabilitation Clinic/CenterTaxonomy code 261QR0400X
Legal business name
TUOLUMNE COUNTY CCS - SOULSBYVILLE MTU
Practice address
20300 Soulsbyville Rd
Soulsbyville, CA 95372-9738
Phone
(209) 532-5198
NPI assigned
Mar 16, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Kathy Amos
Title
Director of Public Health Nursing
Phone
(209) 533-7403

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rehabilitation Clinic/Center 261QR0400X Primary

Addresses

Primary practice location

20300 Soulsbyville Rd
Soulsbyville, CA 95372-9738

Mailing address

2 S Green St
Sonora, CA 95370-4618

Other identifiers 1

IdentifierTypeStateIssuer
CCS00120FMedicaidCA

National Provider Directory

National Provider Directory
Tax ID family
Tuolumne County39 organizations share this tax ID, including this one

Other organizations with this tax ID 38

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

View all 38

Locations

2 S Green St
Sonora, CA 95370

20300 Soulsbyville Rd
Soulsbyville, CA 95372
Phone (209) 532-5198

NPI Registry JSON

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

{
    "created_epoch": "1174003200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1457485617",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2 S GREEN ST",
            "city": "SONORA",
            "state": "CA",
            "postal_code": "953704618"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20300 SOULSBYVILLE RD",
            "city": "SOULSBYVILLE",
            "state": "CA",
            "postal_code": "953729738",
            "telephone_number": "209-532-5198"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TUOLUMNE COUNTY CCS - SOULSBYVILLE MTU",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-16",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "AMOS",
        "authorized_official_first_name": "KATHY",
        "authorized_official_title_or_position": "DIRECTOR OF PUBLIC HEALTH NURSING",
        "authorized_official_telephone_number": "209-533-7403"
    },
    "taxonomies": [
        {
            "code": "261QR0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "CCS00120F",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Soulsbyville, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.