Basic Information
| Provider Information | |||||||||
| NPI: | 1588914584 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MARIE GREEN PSYCHIATRIC CENTER MERCED | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1940 VISTANA DR | ||||||||
| Address2: | |||||||||
| City: | ATWATER | ||||||||
| State: | CA | ||||||||
| PostalCode: | 953015303 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2097235330 | ||||||||
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| Practice Location | |||||||||
| Address1: | 300 E 15TH ST | ||||||||
| Address2: | |||||||||
| City: | MERCED | ||||||||
| State: | CA | ||||||||
| PostalCode: | 953416217 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2093816879 | ||||||||
| FaxNumber: | 2093816871 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/17/2012 | ||||||||
| LastUpdateDate: | 09/17/2012 | ||||||||
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| AuthorizedOfficialLastName: | BASSI | ||||||||
| AuthorizedOfficialFirstName: | BALJINDER | ||||||||
| AuthorizedOfficialMiddleName: | K | ||||||||
| AuthorizedOfficialTitleorPosition: | LVN/LMHW | ||||||||
| AuthorizedOfficialTelephone: | 2093816879 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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| AuthorizedOfficialCredential: | NURSE/PSYCH TECH | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 310500000X | VN198166 | CA | Y | Nursing & Custodial Care Facilities | Intermediate Care Facility, Mental Illness |
No ID Information.