Provider Demographics
NPI:1588914584
Name:MARIE GREEN PSYCHIATRIC CENTER MERCED
Entity type:Organization
Organization Name:MARIE GREEN PSYCHIATRIC CENTER MERCED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LVN/LMHW
Authorized Official - Prefix:MRS
Authorized Official - First Name:BALJINDER
Authorized Official - Middle Name:K
Authorized Official - Last Name:BASSI
Authorized Official - Suffix:
Authorized Official - Credentials:NURSE/PSYCH TECH
Authorized Official - Phone:209-381-6879
Mailing Address - Street 1:1940 VISTANA DR
Mailing Address - Street 2:
Mailing Address - City:ATWATER
Mailing Address - State:CA
Mailing Address - Zip Code:95301-5303
Mailing Address - Country:US
Mailing Address - Phone:209-723-5330
Mailing Address - Fax:
Practice Address - Street 1:300 E 15TH ST
Practice Address - Street 2:
Practice Address - City:MERCED
Practice Address - State:CA
Practice Address - Zip Code:95341-6217
Practice Address - Country:US
Practice Address - Phone:209-381-6879
Practice Address - Fax:209-381-6871
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-17
Last Update Date:2012-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN198166310500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310500000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Mental Illness