Basic Information
| Provider Information | |||||||||
| NPI: | 1578685038 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | COUNTY OF MADERA | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | OAKHURST COUNSELING CENTER SUD | ||||||||
| OtherOrganizationType: | 3 | ||||||||
| OtherLastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1288 | ||||||||
| Address2: | |||||||||
| City: | MADERA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 936391288 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5596733508 | ||||||||
| FaxNumber: | 5596754999 | ||||||||
| Practice Location | |||||||||
| Address1: | 49774 ROAD 426 | ||||||||
| Address2: | SUITE D | ||||||||
| City: | OAKHURST | ||||||||
| State: | CA | ||||||||
| PostalCode: | 936448690 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5596834809 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/04/2007 | ||||||||
| LastUpdateDate: | 12/02/2014 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | KOCH | ||||||||
| AuthorizedOfficialFirstName: | DENNIS | ||||||||
| AuthorizedOfficialMiddleName: | P | ||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR BEHAVIORAL HEALTH SERVICES | ||||||||
| AuthorizedOfficialTelephone: | 5596733508 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
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| AuthorizedOfficialCredential: | MPA | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | Y | Agencies | Community/Behavioral Health |
ID Information
| ID | Type | State | Issuer | Description | 20AC | 01 | CA | MEDICAL DRUG NUMBER | OTHER |