1881752608 NPI number — MOUNTAIN HEALTH & COMMUNITY SERVICES, INC.

Table of content: (NPI 1881752608)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881752608 NPI number — MOUNTAIN HEALTH & COMMUNITY SERVICES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MOUNTAIN HEALTH & COMMUNITY SERVICES, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
MOUNTAIN EMPIRE FAMILY MEDICINE
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1881752608
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/08/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
31115 HIGHWAY 94
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CAMPO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91906-3133
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
619-478-5254
Provider Business Mailing Address Fax Number:
619-478-9164

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
31115 HIGHWAY 94
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CAMPO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91906-3133
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-478-5311
Provider Business Practice Location Address Fax Number:
619-478-2267
Provider Enumeration Date:
12/05/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SHAPLIN
Authorized Official First Name:
JUDITH
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
619-445-6200

Provider Taxonomy Codes

  • Taxonomy code: 261QF0400X , with the licence number:  090000135 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: HAP03814F . This is a "STATE PROGRAM" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: FHC03814F , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: BCP03814F . This is a "STATE PROGRAM" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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