Provider Demographics
NPI:1831435221
Name:EL DORADO MENTAL HEALTH
Entity type:Organization
Organization Name:EL DORADO MENTAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHIATRIC TECHNICIAN
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:EDGAR
Authorized Official - Last Name:MOVINSKY
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:559-361-9595
Mailing Address - Street 1:935B SPRING ST
Mailing Address - Street 2:
Mailing Address - City:PLACERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95667-4523
Mailing Address - Country:US
Mailing Address - Phone:530-621-6213
Mailing Address - Fax:530-622-2385
Practice Address - Street 1:935B SPRING ST
Practice Address - Street 2:
Practice Address - City:PLACERVILLE
Practice Address - State:CA
Practice Address - Zip Code:95667-4523
Practice Address - Country:US
Practice Address - Phone:530-621-6213
Practice Address - Fax:530-622-2385
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-13
Last Update Date:2012-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 36244323P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility