1619191962 NPI number — MADERA COUNTY BEHAVIORAL HEALTH

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619191962 NPI number — MADERA COUNTY BEHAVIORAL HEALTH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MADERA COUNTY BEHAVIORAL HEALTH
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1619191962
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/13/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 100
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OAKHURST
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93644-0100
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
559-642-6872
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
49774 ROAD 426
Provider Second Line Business Practice Location Address:
SUITE D
Provider Business Practice Location Address City Name:
OAKHURST
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93644-8690
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
559-683-4809
Provider Business Practice Location Address Fax Number:
559-683-6499
Provider Enumeration Date:
04/11/2007

Additional Information

Authorized Official

Authorized Official Last Name:
SAMORA
Authorized Official First Name:
LEONARD
Authorized Official Middle Name:
STEVEN
Authorized Official Title or Position:
CERTIFIED ALCOHOL DRUG COUNSELOR
Authorized Official Telephone Number:
559-683-4809

Provider Taxonomy Codes

  • Taxonomy code: 101YA0400X , with the licence number:  FACT 242 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2024 www.npivalidator.com