Provider Demographics
NPI:1205152782
Name:CONTRA COSTA COUNTY
Entity type:Organization
Organization Name:CONTRA COSTA COUNTY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO AND COO
Authorized Official - Prefix:
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:M
Authorized Official - Last Name:GODLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:925-957-5405
Mailing Address - Street 1:50 DOUGLAS DR
Mailing Address - Street 2:SUITE 310-E
Mailing Address - City:MARTINEZ
Mailing Address - State:CA
Mailing Address - Zip Code:94553-4098
Mailing Address - Country:US
Mailing Address - Phone:925-957-5400
Mailing Address - Fax:925-957-5401
Practice Address - Street 1:2425 BISSO LANE
Practice Address - Street 2:SUITE 100
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94520-4817
Practice Address - Country:US
Practice Address - Phone:925-521-5620
Practice Address - Fax:925-521-5639
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CONTRA COSTA COUNTY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-04-09
Last Update Date:2014-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA071MOtherDHCS