Provider Demographics
NPI:1922850494
Name:COUNTY OF MADERA
Entity Type:Organization
Organization Name:COUNTY OF MADERA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MHP/COMPLIANCE AA II
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLEE
Authorized Official - Middle Name:
Authorized Official - Last Name:HERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-673-3508
Mailing Address - Street 1:PO BOX 1288
Mailing Address - Street 2:
Mailing Address - City:MADERA
Mailing Address - State:CA
Mailing Address - Zip Code:93639-1288
Mailing Address - Country:US
Mailing Address - Phone:559-673-3508
Mailing Address - Fax:559-661-2818
Practice Address - Street 1:117 N R ST STE 101
Practice Address - Street 2:
Practice Address - City:MADERA
Practice Address - State:CA
Practice Address - Zip Code:93637-4465
Practice Address - Country:US
Practice Address - Phone:559-662-0527
Practice Address - Fax:559-661-5159
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-05
Last Update Date:2024-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA20AFOtherOTHER (NON-MEDICARE)