Healthcare Provider Details

I. General information

NPI: 1356422307
Provider Name (Legal Business Name): MOUNTAIN COMMUNITIES HEALTHCARE DIST
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2006
Last Update Date: 12/11/2019
Certification Date: 12/11/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31 EASTER AVENUE
WEAVERVILLE CA
96093-1229
US

IV. Provider business mailing address

PO BOX 1229
WEAVERVILLE CA
96093-1229
US

V. Phone/Fax

Practice location:
  • Phone: 530-623-4186
  • Fax: 530-623-4397
Mailing address:
  • Phone: 530-623-4186
  • Fax: 530-623-3920

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number230000038
License Number StateCA

VIII. Authorized Official

Name: MR. AARON ROGERS
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 530-623-2687