NPIMap

Organization Active NPI

South County Mental Health

  • Adult Mental Health Clinic/Center
  • Watsonville, CA
National Provider Identifier
1801930920
Registry record updated Oct 23, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Mental Health Clinic/CenterTaxonomy code 261QM0850X
Legal business name
SOUTH COUNTY MENTAL HEALTH
Practice address
1430 Freedom Blvd
Suite F
Watsonville, CA 95076-2780
Phone
(831) 763-8200
Fax
(831) 454-4663
NPI assigned
Feb 20, 2007
Last updated
Oct 23, 2019By the provider in NPPES
Organization subpart
Yes
Parent organization
COUNTY OF SANTA CRUZAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 23, 2019

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

Authorized official

Name
Jessica Randolph
Title
Director of Administration
Phone
(831) 454-4000

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Mental Health Clinic/Center 261QM0850X CA Primary
Adolescent and Children Mental Health Clinic/Center 261QM0855X CA

Addresses

Primary practice location

1430 Freedom Blvd
Suite F
Watsonville, CA 95076-2780

Mailing address

1400 Emeline Ave
Santa Cruz, CA 95060-1976
Phone (831) 454-4971

Other identifiers 4

IdentifierTypeStateIssuer
1659315430OtherCALEGAL ENTITY NPI#
FHC70044FOtherCASANTA CRUZ COUNTY MEDI-CAL GROUP NUNMBER
4475MedicaidCA
ZZZ91891ZOtherCACOUNTY OF SANTA CRUZ MEDICARE GROUP PTAN#

National Provider Directory

National Provider Directory
Tax ID family
Santa Cruz County Health Services Agency24 organizations share this tax ID, including this one
Part of
Santa Cruz County Health Services Agency

Other organizations with this tax ID 23

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

View all 23

Locations

1430 Freedom Blvd
Ste F
Watsonville, CA 95076
Phone (831) 588-7598

Practitioners & affiliated clinicians

Practitioners 33

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 33

NPI Registry JSON

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

{
    "created_epoch": "1171929600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1571788800000",
    "number": "1801930920",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1400 EMELINE AVE",
            "city": "SANTA CRUZ",
            "state": "CA",
            "postal_code": "950601976",
            "telephone_number": "831-454-4971",
            "fax_number": "831-454-4663"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1430 FREEDOM BLVD",
            "address_2": "SUITE F",
            "city": "WATSONVILLE",
            "state": "CA",
            "postal_code": "950762780",
            "telephone_number": "831-763-8200",
            "fax_number": "831-454-4663"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH COUNTY MENTAL HEALTH",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "COUNTY OF SANTA CRUZ",
        "enumeration_date": "2007-02-20",
        "last_updated": "2019-10-23",
        "status": "A",
        "authorized_official_last_name": "RANDOLPH",
        "authorized_official_first_name": "JESSICA",
        "authorized_official_title_or_position": "DIRECTOR OF ADMINISTRATION",
        "authorized_official_telephone_number": "831-454-4000"
    },
    "taxonomies": [
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": "CA",
            "license": null,
            "primary": true
        },
        {
            "code": "261QM0855X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adolescent and Children Mental Health",
            "state": "CA",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LEGAL ENTITY NPI#",
            "identifier": "1659315430",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SANTA CRUZ COUNTY MEDI-CAL GROUP NUNMBER",
            "identifier": "FHC70044F",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4475",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "COUNTY OF SANTA CRUZ MEDICARE GROUP PTAN#",
            "identifier": "ZZZ91891Z",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Watsonville, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 23, 2019; 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.