Provider Demographics
NPI:1033894761
Name:AMERICAN INDIAN COUNCIL OF MARIPOSA COUNTY
Entity Type:Organization
Organization Name:AMERICAN INDIAN COUNCIL OF MARIPOSA COUNTY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:SPACH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-580-4606
Mailing Address - Street 1:PO BOX 186
Mailing Address - Street 2:
Mailing Address - City:MARIPOSA
Mailing Address - State:CA
Mailing Address - Zip Code:95338-0186
Mailing Address - Country:US
Mailing Address - Phone:209-966-3245
Mailing Address - Fax:
Practice Address - Street 1:4629 HWY 49
Practice Address - Street 2:
Practice Address - City:MARIPOSA
Practice Address - State:CA
Practice Address - Zip Code:95338
Practice Address - Country:US
Practice Address - Phone:209-966-3245
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-20
Last Update Date:2023-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health