Provider Demographics
NPI:1205980547
Name:DEPARTMENT OF HEALTH SERVICES
Entity type:Organization
Organization Name:DEPARTMENT OF HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DHS DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TINA
Authorized Official - Middle Name:
Authorized Official - Last Name:RIVERA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:707-565-7901
Mailing Address - Street 1:418 RILEY ST
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95404-4256
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:418 RILEY ST
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95404-4256
Practice Address - Country:US
Practice Address - Phone:707-565-4567
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COUNTY OF SONOMA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-01-23
Last Update Date:2021-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ15736ZMedicare PIN