Organization
COUNTY OF MENDOCINO
Active
Organization subpart
No
Provider details
NPI number
Authorized official
HEATHER CRISS (PROGRAM ADMINISTRATOR)
(707) 468-7061
Entity
Organization
Contact information
Practice address
737 S STATE ST., ATTENTION: HEATHER CRISS, UKIAH, CA 95482-9548
(707) 468-7061
(707) 463-7744
Mailing address
747 S STATE ST., ATTENTION: HEATHER CRISS, UKIAH, CA 95482
(707) 468-7061
Taxonomy
Speciality
Code
Description
License number
State
251K00000X
Public Health or Welfare Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1275941676
—
CA
Enumeration date
12/19/2022
Last updated
01/05/2023
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