Provider Demographics
NPI:1063056976
Name:COUNTY OF MARIPOSA
Entity type:Organization
Organization Name:COUNTY OF MARIPOSA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SR. ADMINISTRATIVE ANALYST
Authorized Official - Prefix:
Authorized Official - First Name:RANDALL
Authorized Official - Middle Name:
Authorized Official - Last Name:RIDENHOUR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:209-966-2000
Mailing Address - Street 1:PO BOX 5
Mailing Address - Street 2:
Mailing Address - City:MARIPOSA
Mailing Address - State:CA
Mailing Address - Zip Code:95338-0005
Mailing Address - Country:US
Mailing Address - Phone:209-966-3689
Mailing Address - Fax:
Practice Address - Street 1:5300 STATE HIGHWAY 49N
Practice Address - Street 2:
Practice Address - City:MARIPOSA
Practice Address - State:CA
Practice Address - Zip Code:95338
Practice Address - Country:US
Practice Address - Phone:209-966-3689
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MARIPOSA COUNTY BEHAVIORAL HEALTH & RECOVERY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-11-04
Last Update Date:2019-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty