Provider Demographics
NPI:1669004750
Name:ALPINE COUNTY BHS-DMC
Entity Type:Organization
Organization Name:ALPINE COUNTY BHS-DMC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FISCAL & ADMINISTRATIVE SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:THORNBURG
Authorized Official - Last Name:ELLIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:530-694-1816
Mailing Address - Street 1:75 DIAMOND VALLEY RD UNIT C
Mailing Address - Street 2:
Mailing Address - City:MARKLEEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:96120-9579
Mailing Address - Country:US
Mailing Address - Phone:530-694-1816
Mailing Address - Fax:530-694-2387
Practice Address - Street 1:75C DIAMOND VALLEY RD STE I
Practice Address - Street 2:
Practice Address - City:MARKLEEVILLE
Practice Address - State:CA
Practice Address - Zip Code:96120-9512
Practice Address - Country:US
Practice Address - Phone:530-694-1816
Practice Address - Fax:530-694-2387
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-07
Last Update Date:2020-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health