Organization
COUNTY OF MENDOCINO
Active
Parent organization
COUNTY OF MENDOCINO
Organization subpart
Yes
Provider details
NPI number
Legal business name
COUNTY OF MENDOCINO
Authorized official
LESLIE KIRKPATRICK (PROGRAM MANAGER)
(707) 472-2621
Entity
Organization
Contact information
Practice address
790 S FRANKLIN ST, SUITE #B, FORT BRAGG, CA 95437-5456
(707) 472-2621
Mailing address
790 S FRANKLIN ST, SUITE #B, FORT BRAGG, CA 95437-5456
(707) 472-2621
Taxonomy
Speciality
Code
Description
License number
State
251K00000X
Public Health or Welfare Agency
Primary
—
—
261QP0904X
Federal Public Health Clinic/Center
—
—
261QP0905X
State or Local Public Health Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2302
MEDI-CAL #
CA
Enumeration date
08/04/2011
Last updated
08/04/2011
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