MEDICARE: ALPINE COUNTY BEAR V ALLEY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency		CA

General Provider Information

NPI Number	:	1518209709
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALPINE COUNTY BEAR V ALLEY

Provider Business Mailing Address
First Line	:	367 CREEKSIDE DRIVE
Second Line	:	P O BOX 5233
City	:	BEAR VALLEY
State	:	CA
Zip	:	95223
Country	:	US
Telephone Number	:	209-253-2831
Fax Number	:	209-753-2471

Provider Business Practice Location Address
First Line	:	367 CREEKSIDE DRIVE
Second Line	:
City	:	BEAR VALLEY
State	:	CA
Zip	:	95223
Country	:	US
Telephone Number	:	209-253-2831
Fax Number	:	209-753-2471

Authorized Official
Title or Position	:	CAO
Name	:	PAMELA KNORR
Credential	:
Telephone Number	:	530-694-2287

Provider Enumeration Date	:	03/26/2013
Last Update Date	:	03/26/2013

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