Healthcare Provider Details

I. General information

NPI: 1104561257
Provider Name (Legal Business Name): MINISTERIAL ASSOCIATION OF COLUSA COUNTY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2022
Last Update Date: 09/14/2023
Certification Date: 09/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

241 5TH ST
COLUSA CA
95932-2410
US

IV. Provider business mailing address

PO BOX 674
COLUSA CA
95932-0674
US

V. Phone/Fax

Practice location:
  • Phone: 530-473-9050
  • Fax:
Mailing address:
  • Phone: 530-473-9050
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251X00000X
TaxonomySupports Brokerage Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: MR. JASON MCMULLAN
Title or Position: EXECUTIVE DIRECTOR
Credential: REV.
Phone: 530-419-9584