Provider Demographics
NPI:1477985091
Name:COUNTY OF MENDOCINO
Entity Type:Organization
Organization Name:COUNTY OF MENDOCINO
Other - Org Name:HHSA-FAMILY AND CHILDREN'S SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:STAFF SERVICES ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:VENUS
Authorized Official - Middle Name:
Authorized Official - Last Name:HOAGLEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:707-472-2365
Mailing Address - Street 1:727 S STATE ST
Mailing Address - Street 2:
Mailing Address - City:UKIAH
Mailing Address - State:CA
Mailing Address - Zip Code:95482-5815
Mailing Address - Country:US
Mailing Address - Phone:707-463-7919
Mailing Address - Fax:
Practice Address - Street 1:727 S STATE ST
Practice Address - Street 2:
Practice Address - City:UKIAH
Practice Address - State:CA
Practice Address - Zip Code:95482-5815
Practice Address - Country:US
Practice Address - Phone:707-463-7919
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COUNTY OF MENDOCINO
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-08-06
Last Update Date:2013-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health