Provider Demographics
NPI:1174838338
Name:COUNTY OF MADERA
Entity Type:Organization
Organization Name:COUNTY OF MADERA
Other - Org Name:NETWORK PROVIDER MIX 2023
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR BEHAVIORAL HEALTH SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:P
Authorized Official - Last Name:KOCH
Authorized Official - Suffix:
Authorized Official - Credentials:MPA
Authorized Official - Phone:559-673-3508
Mailing Address - Street 1:PO BOX 1288
Mailing Address - Street 2:
Mailing Address - City:MADERA
Mailing Address - State:CA
Mailing Address - Zip Code:93639-1288
Mailing Address - Country:US
Mailing Address - Phone:559-673-3508
Mailing Address - Fax:559-675-4999
Practice Address - Street 1:209 E 7TH ST
Practice Address - Street 2:
Practice Address - City:MADERA
Practice Address - State:CA
Practice Address - Zip Code:93638-3780
Practice Address - Country:US
Practice Address - Phone:559-673-3508
Practice Address - Fax:559-675-4999
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-12
Last Update Date:2015-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health