Provider Demographics
NPI:1730825803
Name:PACIFIC CLINICS
Entity type:Organization
Organization Name:PACIFIC CLINICS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SENIOR VP, CLINICAL ADMINISTRATION
Authorized Official - Prefix:
Authorized Official - First Name:GORDON
Authorized Official - Middle Name:
Authorized Official - Last Name:RICHARDSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-388-6301
Mailing Address - Street 1:499 LOMA ALTA AVE
Mailing Address - Street 2:
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95030-6227
Mailing Address - Country:US
Mailing Address - Phone:408-379-3790
Mailing Address - Fax:408-364-4013
Practice Address - Street 1:7248 S LAND PARK DR STE 103
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95831-3661
Practice Address - Country:US
Practice Address - Phone:916-388-6400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PACIFIC CLINICS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-05-10
Last Update Date:2024-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No251X00000XAgenciesSupports Brokerage