Healthcare Provider Details

I. General information

NPI: 1427470186
Provider Name (Legal Business Name): MENDOCINO COUNTY AIDS VOLUNTEER NETWORK
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/15/2014
Last Update Date: 02/13/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

148 CLARA AVE
UKIAH CA
95482-4002
US

IV. Provider business mailing address

PO BOX 1350
UKIAH CA
95482-1350
US

V. Phone/Fax

Practice location:
  • Phone: 707-462-1932
  • Fax: 707-462-2070
Mailing address:
  • Phone: 707-462-1932
  • Fax: 707-462-2070

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number9902EXEMPT006
License Number StateCA

VIII. Authorized Official

Name: DR. ELIZABETH (LIBBY) GUTHRIE
Title or Position: EXECUTIVE DIRECTOR
Credential: ED.D. & M.A.
Phone: 707-462-1932