Provider Demographics
NPI:1053972885
Name:COUNTY OF CALAVERAS
Entity type:Organization
Organization Name:COUNTY OF CALAVERAS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BHS PROGRAM MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:STACEY
Authorized Official - Middle Name:
Authorized Official - Last Name:MEILY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:209-754-6516
Mailing Address - Street 1:891 MOUNTAIN RANCH RD
Mailing Address - Street 2:
Mailing Address - City:SAN ANDREAS
Mailing Address - State:CA
Mailing Address - Zip Code:95249-9713
Mailing Address - Country:US
Mailing Address - Phone:209-754-6525
Mailing Address - Fax:209-754-6597
Practice Address - Street 1:590 TOYANZA DRIVE
Practice Address - Street 2:
Practice Address - City:SAN ANDREAS
Practice Address - State:CA
Practice Address - Zip Code:95249-9713
Practice Address - Country:US
Practice Address - Phone:209-754-6525
Practice Address - Fax:209-754-6597
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CALAVERAS COUNTY SUBSTANCE ABUSE PROGRAM
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-06-24
Last Update Date:2025-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder