Provider Demographics
NPI:1275941676
Name:MENDOCINO COUNTY
Entity Type:Organization
Organization Name:MENDOCINO COUNTY
Other - Org Name:COUNTY OF MENDOCINO HEALTH & HUMAN SERVICES PUBLIC HEALTH BRANCH
Other - Org Type:Other Name
Authorized Official - Title/Position:DEPUTY DIRECTOR OF NURSING
Authorized Official - Prefix:
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:
Authorized Official - Last Name:CONVERY
Authorized Official - Suffix:
Authorized Official - Credentials:PHN
Authorized Official - Phone:707-472-2707
Mailing Address - Street 1:1120 S DORA ST
Mailing Address - Street 2:
Mailing Address - City:UKIAH
Mailing Address - State:CA
Mailing Address - Zip Code:95482-6340
Mailing Address - Country:US
Mailing Address - Phone:707-472-2730
Mailing Address - Fax:707-472-2735
Practice Address - Street 1:1120 S DORA ST
Practice Address - Street 2:
Practice Address - City:UKIAH
Practice Address - State:CA
Practice Address - Zip Code:95482-6340
Practice Address - Country:US
Practice Address - Phone:707-472-2730
Practice Address - Fax:707-472-2735
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-29
Last Update Date:2014-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA36SC1501X251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare