Provider Demographics
NPI:1871286070
Name:DEPARTMENT OF MENTAL HEALTH PALMDALE MENTAL HEALTH CENTER
Entity type:Organization
Organization Name:DEPARTMENT OF MENTAL HEALTH PALMDALE MENTAL HEALTH CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PROGRAM MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:COMACHO FUENTES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:661-575-1800
Mailing Address - Street 1:1529 E PALMDALE BLVD STE 150
Mailing Address - Street 2:
Mailing Address - City:PALMDALE
Mailing Address - State:CA
Mailing Address - Zip Code:93550-2038
Mailing Address - Country:US
Mailing Address - Phone:661-575-1800
Mailing Address - Fax:
Practice Address - Street 1:1529 E PALMDALE BLVD STE 150
Practice Address - Street 2:
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93550-2038
Practice Address - Country:US
Practice Address - Phone:661-575-1800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-01
Last Update Date:2023-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty