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General NPI Number Information
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NPI Number | 1578428355
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Entity Type | Organization
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Legal Business Name | COUNTY OF MENDOCINO JUVENILE HALL
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Dates
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Enumeration Date | 12/23/2025
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Last Update Date | 12/23/2025
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Provider Practice Location Address
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Address Line | 585 LOW GAP RD
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City | UKIAH
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State | CA
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Zip | 95482-3734
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Country | US
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Telephone | 707-234-6682
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Fax |
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Provider Business Mailing Address
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Address Line | 585 LOW GAP RD
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City | UKIAH
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State | CA
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Zip | 95482-3734
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Country | US
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Telephone | 707-234-6682
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Fax |
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Authorized Official
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Title or Position | ASSISTANT CHIEF PROBATION OFFICER
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Name | MS. KATHERINE FORD
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Credential |
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Telephone | 707-234-6904
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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