Healthcare Provider Details

I. General information

NPI: 1982658142
Provider Name (Legal Business Name): MOUNTAIN HEALTH & COMMUNITY SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2006
Last Update Date: 02/07/2020
Certification Date: 02/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1388 BUCKMAN SPRINGS RD
CAMPO CA
91906-2028
US

IV. Provider business mailing address

31115 HIGHWAY 94
CAMPO CA
91906-3133
US

V. Phone/Fax

Practice location:
  • Phone: 619-478-5254
  • Fax: 619-478-9164
Mailing address:
  • Phone: 619-478-5254
  • Fax: 619-478-9164

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: JUDITH SHAPLIN
Title or Position: CEO
Credential:
Phone: 619-445-6200