Provider Demographics
NPI:1083330807
Name:MENDONOMA HEALTH ALLIANCE
Entity Type:Organization
Organization Name:MENDONOMA HEALTH ALLIANCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHELINE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:707-412-3176
Mailing Address - Street 1:PO BOX 1196
Mailing Address - Street 2:
Mailing Address - City:GUALALA
Mailing Address - State:CA
Mailing Address - Zip Code:95445-1196
Mailing Address - Country:US
Mailing Address - Phone:707-412-3176
Mailing Address - Fax:707-412-3196
Practice Address - Street 1:39251 CA-1
Practice Address - Street 2:
Practice Address - City:GUALALA
Practice Address - State:CA
Practice Address - Zip Code:95445
Practice Address - Country:US
Practice Address - Phone:707-412-3176
Practice Address - Fax:707-412-3196
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-13
Last Update Date:2022-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management