NPIMap

Organization Active NPI

County of Mendocino

  • Community/Behavioral Health Agency
  • Ukiah, CA
National Provider Identifier
1972658128
Registry record updated Dec 2, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
Legal business name
COUNTY OF MENDOCINO
Practice address
1120 S Dora St
Ukiah, CA 95482-3919
Phone
(707) 463-4303
NPI assigned
Jan 25, 2007
Last updated
Dec 2, 2023By the provider in NPPES
Organization subpart
Yes
Parent organization
COUNTY OF MENDOCINOAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Dec 2, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Jenine Miller, PSY.D.NPI 1346404472
Title
BHRS Director
Phone
(707) 472-2341

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Case Management Agency 251B00000X NU
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X NU
Exclusive Provider Organization 302F00000X NU
Community/Behavioral Health Agency 251S00000X NU Primary

Addresses

Primary practice location

1120 S Dora St
Ukiah, CA 95482-3919

Mailing address

1120 S Dora St
Ukiah, CA 95482-6340
Phone (707) 472-2300

Other identifiers 4

IdentifierTypeStateIssuer
00023OtherCAMH COUNTY MEDICAL INDENTI
BBB33295BOtherCAMH SUBMITTER NUMBER
2315MedicaidCA
2315OtherCAMEDICAL PROVIDER #

Other names 1

  • Behavioral Health & Recovery Services - Mental Health Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040520001485 CA Part B Supplier - Clinic/Group Practice 8325033301 Receives reassigned benefits from 1 practitioner
2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Fort Bragg, CA; Willits, CA; Ukiah, CA

Other NPIs on the same Medicare enrollment 2

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Mendocino County Health12 organizations share this tax ID, including this one
Part of
Mendocino County Health

Other organizations with this tax ID 11

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1169683200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1701475200000",
    "number": "1972658128",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1120 S DORA ST",
            "city": "UKIAH",
            "state": "CA",
            "postal_code": "954826340",
            "telephone_number": "707-472-2300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1120 S DORA ST",
            "city": "UKIAH",
            "state": "CA",
            "postal_code": "954823919",
            "telephone_number": "707-463-4303"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COUNTY OF MENDOCINO",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "COUNTY OF MENDOCINO",
        "enumeration_date": "2007-01-25",
        "last_updated": "2023-12-02",
        "certification_date": "2023-12-02",
        "status": "A",
        "authorized_official_last_name": "MILLER",
        "authorized_official_first_name": "JENINE",
        "authorized_official_title_or_position": "BHRS DIRECTOR",
        "authorized_official_telephone_number": "707-472-2341",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PSY.D."
    },
    "taxonomies": [
        {
            "code": "251B00000X",
            "taxonomy_group": "",
            "desc": "Case Management",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "302F00000X",
            "taxonomy_group": "",
            "desc": "Exclusive Provider Organization",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MH COUNTY MEDICAL INDENTI",
            "identifier": "00023",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MH SUBMITTER NUMBER",
            "identifier": "BBB33295B",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2315",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAL PROVIDER #",
            "identifier": "2315",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Behavioral Health & Recovery Services - Mental Health",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Ukiah, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 2, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.