Provider Demographics
NPI:1730212937
Name:EL DORADO COUNTY CCS
Entity type:Organization
Organization Name:EL DORADO COUNTY CCS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PUBLIC HEALTH DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:GAYLE
Authorized Official - Middle Name:
Authorized Official - Last Name:ERBE-HAMLIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:530-621-6191
Mailing Address - Street 1:931 SPRING ST
Mailing Address - Street 2:
Mailing Address - City:PLACERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95667-4543
Mailing Address - Country:US
Mailing Address - Phone:530-621-6128
Mailing Address - Fax:530-622-5109
Practice Address - Street 1:1100 LYONS AVE
Practice Address - Street 2:
Practice Address - City:SOUTH LAKE TAHOE
Practice Address - State:CA
Practice Address - Zip Code:96150-8252
Practice Address - Country:US
Practice Address - Phone:530-543-2313
Practice Address - Fax:530-543-2275
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACCS00108FMedicaid