Basic Information
| Provider Information | |||||||||
| NPI: | 1952588337 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MADERA COUNTY BEHAVIORAL HEALTH SERVICES | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1288 | ||||||||
| Address2: | |||||||||
| City: | MADERA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 936391288 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5596733508 | ||||||||
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| Practice Location | |||||||||
| Address1: | 14277 ROAD 28 | ||||||||
| Address2: | |||||||||
| City: | MADERA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 936385715 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5596733508 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/28/2008 | ||||||||
| LastUpdateDate: | 01/28/2008 | ||||||||
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| AuthorizedOfficialLastName: | PARTRIDGE | ||||||||
| AuthorizedOfficialFirstName: | AURA | ||||||||
| AuthorizedOfficialMiddleName: | MARIA | ||||||||
| AuthorizedOfficialTitleorPosition: | MENTAL HEALTH CASEWORKER 1 | ||||||||
| AuthorizedOfficialTelephone: | 5596733508 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | Y | Agencies | Community/Behavioral Health |
ID Information
| ID | Type | State | Issuer | Description | ZZZ02270Z | 05 | CA | MEDICAID |