Provider Demographics
NPI: | 1609172766 |
---|---|
Name: | COUNTY OF MERCED |
Entity Type: | Organization |
Organization Name: | COUNTY OF MERCED |
Other - Org Name: | BHRS ADULT WELLNESS CENTER |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | COMPLIANCE OFFICER |
Authorized Official - Prefix: | MR |
Authorized Official - First Name: | KURT |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | CRAIG |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | CIPP/US |
Authorized Official - Phone: | 209-381-6818 |
Mailing Address - Street 1: | PO BOX 2087 |
Mailing Address - Street 2: | |
Mailing Address - City: | MERCED |
Mailing Address - State: | CA |
Mailing Address - Zip Code: | 95344-0087 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 209-381-6800 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 301 E 13TH ST STE B |
Practice Address - Street 2: | |
Practice Address - City: | MERCED |
Practice Address - State: | CA |
Practice Address - Zip Code: | 95341-6211 |
Practice Address - Country: | US |
Practice Address - Phone: | 209-381-6800 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2011-02-07 |
Last Update Date: | 2019-08-08 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 261QR0400X | Ambulatory Health Care Facilities | Clinic/Center | Rehabilitation |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
CA | 24AM | Medicaid |