Provider Demographics
NPI:1619191962
Name:MADERA COUNTY BEHAVIORAL HEALTH
Entity Type:Organization
Organization Name:MADERA COUNTY BEHAVIORAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CERTIFIED ALCOHOL DRUG COUNSELOR
Authorized Official - Prefix:MR
Authorized Official - First Name:LEONARD
Authorized Official - Middle Name:STEVEN
Authorized Official - Last Name:SAMORA
Authorized Official - Suffix:
Authorized Official - Credentials:FACT 242
Authorized Official - Phone:559-683-4809
Mailing Address - Street 1:PO BOX 100
Mailing Address - Street 2:
Mailing Address - City:OAKHURST
Mailing Address - State:CA
Mailing Address - Zip Code:93644-0100
Mailing Address - Country:US
Mailing Address - Phone:559-642-6872
Mailing Address - Fax:
Practice Address - Street 1:49774 ROAD 426
Practice Address - Street 2:SUITE D
Practice Address - City:OAKHURST
Practice Address - State:CA
Practice Address - Zip Code:93644-8690
Practice Address - Country:US
Practice Address - Phone:559-683-4809
Practice Address - Fax:559-683-6499
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-11
Last Update Date:2008-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAFACT 242101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA=========Medicare UPIN