Provider Demographics
NPI:1972039105
Name:ALPINE COUNTY BEHAVIORAL HEALTH SERVICES
Entity Type:Organization
Organization Name:ALPINE COUNTY BEHAVIORAL HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BHS DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ALISSA
Authorized Official - Middle Name:R
Authorized Official - Last Name:NOURSE
Authorized Official - Suffix:
Authorized Official - Credentials:MED
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 1:75 DIAMOND VALLEY RD UNIT C
Practice Address - Street 2:
Practice Address - City:MARKLEEVILLE
Practice Address - State:CA
Practice Address - Zip Code:96120-9579
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:2017-05-09
Last Update Date:2017-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALR02471016305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service