NPIMap

Organization Active NPI

El Dorado County CCS

  • Rehabilitation Clinic/Center
  • South Lake Tahoe, CA
National Provider Identifier
1730212937
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rehabilitation Clinic/CenterTaxonomy code 261QR0400X
Legal business name
EL DORADO COUNTY CCS
Practice address
1100 Lyons Ave
South Lake Tahoe, CA 96150-8252
Phone
(530) 543-2313
Fax
(530) 543-2275
NPI assigned
Mar 14, 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
Ms. Gayle Erbe-Hamlin
Title
Public Health Director
Phone
(530) 621-6191

Specialties & licenses 1

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

Addresses

Primary practice location

1100 Lyons Ave
South Lake Tahoe, CA 96150-8252

Mailing address

931 Spring St
Placerville, CA 95667-4543
Phone (530) 621-6128

Other identifiers 1

IdentifierTypeStateIssuer
CCS00108FMedicaidCA

Other names 1

  • South Lake Tahoe MTU Doing business as

National Provider Directory

National Provider Directory
Tax ID family
El Dorado County Ambula22 organizations share this tax ID, including this one

Other organizations with this tax ID 21

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

View all 21

Locations

931 Spring St
Placerville, CA 95667
Phone (530) 621-6100

1100 Lyons Ave
South Lake Tahoe, CA 96150
Phone (530) 307-4046

NPI Registry JSON

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

{
    "created_epoch": "1173830400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1730212937",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "931 SPRING ST",
            "city": "PLACERVILLE",
            "state": "CA",
            "postal_code": "956674543",
            "telephone_number": "530-621-6128",
            "fax_number": "530-622-5109"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1100 LYONS AVE",
            "city": "SOUTH LAKE TAHOE",
            "state": "CA",
            "postal_code": "961508252",
            "telephone_number": "530-543-2313",
            "fax_number": "530-543-2275"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EL DORADO COUNTY CCS",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-14",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "ERBE-HAMLIN",
        "authorized_official_first_name": "GAYLE",
        "authorized_official_title_or_position": "PUBLIC HEALTH  DIRECTOR",
        "authorized_official_telephone_number": "530-621-6191",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "261QR0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "CCS00108F",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "South Lake Tahoe MTU",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in South Lake Tahoe, 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.