Provider Demographics
NPI:1598807190
Name:COMMUNITY ACTION PARTNERSHIP OF SONOMA COUNTY
Entity type:Organization
Organization Name:COMMUNITY ACTION PARTNERSHIP OF SONOMA COUNTY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:AGENCY GRANT MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:NATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:707-544-6911
Mailing Address - Street 1:2250 NORTHPOINT PKWY
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95407-7398
Mailing Address - Country:US
Mailing Address - Phone:707-544-6911
Mailing Address - Fax:707-526-2918
Practice Address - Street 1:1260 N DUTTON AVE STE 220
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95401-4686
Practice Address - Country:US
Practice Address - Phone:707-544-6911
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-12
Last Update Date:2024-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA110000314261QC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA110000314OtherCLINIC LICENSE NUMBER
CACMM70706FMedicaid