=====================================================
General NPI Number Information
=====================================================
NPI Number | 1407737927
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MODOC COUNTY CHILDREN AND FAMILIES COMMISSION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/10/2025
-----------------------------------------------------
Last Update Date | 09/10/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 300 W 1ST ST
-----------------------------------------------------
City | ALTURAS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 96101-3905
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 530-233-7122
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 300 W 1ST ST
-----------------------------------------------------
City | ALTURAS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 96101-3905
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 530-233-7122
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | COMMUNITY HEALTH WORKER
-----------------------------------------------------
Name | MS. JENNIFER ROSE MCCAFFREY
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 530-233-7122
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171M00000X
-----------------------------------------------------
Taxonomy Name | Case Manager/Care Coordinator
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------