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NPI Code Detail

MEDICARE: COUNTY OF MADERA

MEDICARE: COUNTY OF MADERA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1251S00000XCommunity/Behavioral Health Agency

General Provider Information

NPI Number : 1578315073
Entity Type Code : Organization
Provider Name (Legal Business Name) : COUNTY OF MADERA
Provider Business Mailing Address
First Line : PO BOX 1288
Second Line :
City : MADERA
State : CA
Zip : 93639-1288
Country : US
Telephone Number : 559-673-3508
Fax Number : 559-661-2818
Provider Business Practice Location Address
First Line : 12390 GOLDEN STATE BLVD
Second Line :
City : MADERA
State : CA
Zip : 93637-9156
Country : US
Telephone Number : 559-673-3508
Fax Number : 559-661-2818
Authorized Official
Title or Position : MHP/COMPLIANCE AA II
Name : KIMBERLEE HERNANDEZ
Credential :
Telephone Number : 559-673-3508
Provider Enumeration Date : 04/05/2024
Last Update Date : 04/05/2024

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Directions to “COUNTY OF MADERA ” Practice Location

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