Provider Demographics
NPI:1518209709
Name:ALPINE COUNTY BEAR V ALLEY
Entity Type:Organization
Organization Name:ALPINE COUNTY BEAR V ALLEY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CAO
Authorized Official - Prefix:
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:
Authorized Official - Last Name:KNORR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:530-694-2287
Mailing Address - Street 1:367 CREEKSIDE DRIVE
Mailing Address - Street 2:P O BOX 5233
Mailing Address - City:BEAR VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95223
Mailing Address - Country:US
Mailing Address - Phone:209-253-2831
Mailing Address - Fax:209-753-2471
Practice Address - Street 1:367 CREEKSIDE DRIVE
Practice Address - Street 2:
Practice Address - City:BEAR VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95223
Practice Address - Country:US
Practice Address - Phone:209-253-2831
Practice Address - Fax:209-753-2471
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-26
Last Update Date:2013-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACR828AMedicare PIN
CA1659690857Medicare PIN