Basic Information
| Provider Information | |||||||||
| NPI: | 1912147851 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | SOUTH TULARE COUNTY MOBILE UNIT | ||||||||
| LastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 201 N K ST | ||||||||
| Address2: | |||||||||
| City: | TULARE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 932744005 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5596870929 | ||||||||
| FaxNumber: | 5596858953 | ||||||||
| Practice Location | |||||||||
| Address1: | 201 N K ST | ||||||||
| Address2: | |||||||||
| City: | TULARE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 932744005 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5596870929 | ||||||||
| FaxNumber: | 5596858953 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/05/2009 | ||||||||
| LastUpdateDate: | 03/05/2009 | ||||||||
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| AuthorizedOfficialLastName: | HERRERA | ||||||||
| AuthorizedOfficialFirstName: | MICHELLE | ||||||||
| AuthorizedOfficialMiddleName: | ANN | ||||||||
| AuthorizedOfficialTitleorPosition: | CASE MANAGER 1 | ||||||||
| AuthorizedOfficialTelephone: | 5596870929 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | KINGSVIEW CORPORATION | ||||||||
| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251B00000X | Y | Agencies | Case Management |
No ID Information.