Provider Demographics
NPI:1629107735
Name:MENDOCINO COUNTY
Entity Type:Organization
Organization Name:MENDOCINO COUNTY
Other - Org Name:BEHAVIORAL HEALTH & RECOVERY SERVICES - MENTAL HEALTH
Other - Org Type:Other Name
Authorized Official - Title/Position:BHRS DEPUTY DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JENINE
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:707-472-2300
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:707-472-2300
Mailing Address - Fax:707-472-2331
Practice Address - Street 1:474 E VALLEY ST
Practice Address - Street 2:
Practice Address - City:WILLITS
Practice Address - State:CA
Practice Address - Zip Code:95490-3606
Practice Address - Country:US
Practice Address - Phone:707-472-2300
Practice Address - Fax:707-472-2331
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-05
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No251B00000XAgenciesCase Management
No251S00000XAgenciesCommunity/Behavioral Health
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No302F00000XManaged Care OrganizationsExclusive Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA2367Medicaid
CA00023Medicaid
CABBB33295BOtherMH SUBMITTER #
CA2367Medicaid
CA156456Medicare ID - Type UnspecifiedMH MEDICARE RECEIVER