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General NPI Number Information
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NPI Number | 1669385258
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Entity Type | Organization
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Legal Business Name | M A C T HEALTH BOARD, INCORPORATED
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Dates
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Enumeration Date | 09/24/2026
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Last Update Date | 09/24/2026
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Provider Practice Location Address
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Address Line | 11321 PROSPECT DR STE 6
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City | JACKSON
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State | CA
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Zip | 95642-9390
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Country | US
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Telephone | 209-257-2450
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Fax | 209-660-2040
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Provider Business Mailing Address
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Address Line | PO BOX 939
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City | ANGELS CAMP
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State | CA
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Zip | 95222-0939
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Country | US
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Telephone | 209-288-6262
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Fax | 209-736-1814
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MARIELA CONTRERAS
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Credential | MBA
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Telephone | 209-754-6262
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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 | 261QF0400X
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Taxonomy Name | Federally Qualified Health Center (FQHC)
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License Number |
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License Number State |
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