Organization
COUNTY OF MADERA
Active
Organization
COUNTY OF MADERA
Active
Other names
Children, Youth & Family Recovery Center SUD
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLEE HERNANDEZ (MHP/COMPLIANCE AA II)
(559) 673-3508
Entity
Organization
Contact information
Practice address
117 N R ST STE 101, MADERA, CA 93637-4465
(559) 662-0527
(559) 661-5159
Mailing address
PO BOX 1288, MADERA, CA 93639-1288
(559) 673-3508
(559) 661-2818
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
20AF
OTHER (NON-MEDICARE)
CA
Enumeration date
04/05/2024
Last updated
04/05/2024
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