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General NPI Number Information
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NPI Number | 1871042515
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Entity Type | Organization
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Legal Business Name | MODOC COUNTY BEHAVIORAL HEALTH
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Dates
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Enumeration Date | 09/22/2016
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Last Update Date | 09/22/2016
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Provider Practice Location Address
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Address Line | 441 N MAIN ST
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City | ALTURAS
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State | CA
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Zip | 96101-3457
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Country | US
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Telephone | 530-233-6312
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Fax | 530-233-6339
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Provider Business Mailing Address
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Address Line | 441 N MAIN ST
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City | ALTURAS
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State | CA
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Zip | 96101-3457
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Country | US
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Telephone | 530-233-6312
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Fax | 530-233-6339
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Authorized Official
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Title or Position | HEALTH PROGRAM MANAGER
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Name | MS. DEBBIE DALE STEWART
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Credential | RN
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Telephone | 530-233-6312
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 527673
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License Number State | CA
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