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1400 N Norma St Ste 125-133 Ridgecrest CA 93555-2575 | |
| (760) 499-7406 | |
| (760) 499-7479 |
| Full Name | |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 1400 N Norma St Ste 125-133, Ridgecrest, California |
| Authorized Official Name and Position | Tracy Ginter (DIRECTOR OF STATE OPERATIONS) |
| Authorized Official Contact | 6574659497 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
8337 Telegraph Rd Ste 300 Pico Rivera CA 90660-4957 Ph: (562) 467-5440 | 1400 N Norma St Ste 125-133 Ridgecrest CA 93555-2575 Ph: (760) 499-7406 |
| NPI Number | 1225241417 |
|---|---|
| Provider Enumeration Date | 05/07/2007 |
| Last Update Date | 06/03/2024 |
| Certification Date | 06/03/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1225241417 | NPI | - | NPPES |
| 15AI | Medicaid | CA | |
| 15AP | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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