Healthcare Provider Details

I. General information

NPI: 1922850494
Provider Name (Legal Business Name): COUNTY OF MADERA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/05/2024
Last Update Date: 04/05/2024
Certification Date: 04/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

117 N R ST STE 101
MADERA CA
93637-4465
US

IV. Provider business mailing address

PO BOX 1288
MADERA CA
93639-1288
US

V. Phone/Fax

Practice location:
  • Phone: 559-662-0527
  • Fax: 559-661-5159
Mailing address:
  • Phone: 559-673-3508
  • Fax: 559-661-2818

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: KIMBERLEE HERNANDEZ
Title or Position: MHP/COMPLIANCE AA II
Credential:
Phone: 559-673-3508