Provider Demographics
NPI:1134655970
Name:MHN GOVERNMENT SERVICES LLC
Entity Type:Organization
Organization Name:MHN GOVERNMENT SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:
Authorized Official - First Name:BILLY
Authorized Official - Middle Name:
Authorized Official - Last Name:MAYNARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-353-6100
Mailing Address - Street 1:2025 AEROJET RD
Mailing Address - Street 2:
Mailing Address - City:RANCHO CORDOVA
Mailing Address - State:CA
Mailing Address - Zip Code:95742-6418
Mailing Address - Country:US
Mailing Address - Phone:916-353-6100
Mailing Address - Fax:916-353-6809
Practice Address - Street 1:1941 OFARRELL ST
Practice Address - Street 2:SUITE 114
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94403-1340
Practice Address - Country:US
Practice Address - Phone:650-286-2162
Practice Address - Fax:650-572-0274
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-11
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA41-006-01-120261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder