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General NPI Number Information
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NPI Number | 1407080898
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Entity Type | Organization
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Legal Business Name | COUNTY OF MENDOCINO
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Dates
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Enumeration Date | 05/13/2009
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Last Update Date | 05/13/2009
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Provider Practice Location Address
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Address Line | 405 OBSERVATORY AVE
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City | UKIAH
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State | CA
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Zip | 95482-5641
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Country | US
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Telephone | 707-472-2607
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Fax |
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Provider Business Mailing Address
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Address Line | 405 OBSERVATORY AVE
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City | UKIAH
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State | CA
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Zip | 95482-5641
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Country | US
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Telephone | 707-472-2607
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Fax |
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Authorized Official
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Title or Position | PROGRAM MANAGER
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Name | PATRICIA GUNTLEY
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Credential |
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Telephone | 707-472-2607
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QP0904X
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Taxonomy Name | Federal Public Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QP0905X
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Taxonomy Name | State or Local Public Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 261QP2400X
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Taxonomy Name | Prison Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 251K00000X
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Taxonomy Name | Public Health or Welfare Agency
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License Number |
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License Number State |
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