| |
1297 W Hobsonway Blythe CA 92225-1423 | |
(760) 921-5019 | |
(760) 921-5010 |
Full Name | |
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Speciality | Community/behavioral Health |
Location | 1297 W Hobsonway, Blythe, California |
Authorized Official Name and Position | Jerry A Wengerd (DIRECTOR, DEPT. OF MENTAL HEALTH) |
Authorized Official Contact | 9513584501 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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3525 Presley Ave Riverside CA 92507-4453 Ph: (951) 782-2400 | 1297 W Hobsonway Blythe CA 92225-1423 Ph: (760) 921-5019 |
NPI Number | 1285700435 |
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Provider Enumeration Date | 11/28/2006 |
Last Update Date | 12/10/2014 |
Identifier | Type | State | Issuer |
---|---|---|---|
1285700435 | NPI | - | NPPES |
333365 | Other | CA | CADDS |
3365 | Medicaid | CA |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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