Organization
COUNTY OF MENDOCINO
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANA MAHONEY (DIRECTOR)
(707) 472-2789
Entity
Organization
Contact information
Practice address
860 N BUSH ST, UKIAH, CA 95482-3919
(707) 463-4303
Mailing address
501 LOW GAP RD, UKIAH, CA 95482-3738
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
—
—
251J00000X
Nursing Care Agency
—
—
251K00000X
Public Health or Welfare Agency
—
—
251S00000X
Community/Behavioral Health Agency
Primary
—
—
261Q00000X
Clinic/Center
—
—
261QC1500X
Community Health Clinic/Center
—
—
261QF0050X
Non-Surgical Family Planning Clinic/Center
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
—
—
261QP0905X
State or Local Public Health Clinic/Center
—
—
291U00000X
Clinical Medical Laboratory
—
—
302F00000X
Exclusive Provider Organization
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00023
MH COUNTY MEDICAL IDENTIF
CA
01
—
2302
AODP DRUG MEDICAL WILLITS
CA
01
—
2305
AODP DRUG MEDICAL UKIAH
CA
01
—
2306
AODP DRUG MEDICAL FTBRAGG
CA
01
—
LAB58594F
PH LAB MEDICAL INDENTIFIE
CA
01
—
ZZR11485F
PH MEDICAL IDENTIFIER
CA
Enumeration date
11/28/2006
Last updated
12/28/2011
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