Provider Demographics
NPI:1639060213
Name:COUNTY OF MENDOCINO
Entity type:Organization
Organization Name:COUNTY OF MENDOCINO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SHERIFF'S CAPTAIN / JAIL COMMANDER
Authorized Official - Prefix:MR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:VAN PATTEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:707-463-4083
Mailing Address - Street 1:951 LOW GAP RD
Mailing Address - Street 2:
Mailing Address - City:UKIAH
Mailing Address - State:CA
Mailing Address - Zip Code:95482-3736
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:951 LOW GAP RD
Practice Address - Street 2:
Practice Address - City:UKIAH
Practice Address - State:CA
Practice Address - Zip Code:95482-3736
Practice Address - Country:US
Practice Address - Phone:707-463-4083
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COUNTY OF MENDOCINO
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-07-11
Last Update Date:2025-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2400XAmbulatory Health Care FacilitiesClinic/CenterPrison Health