Healthcare Provider Details

I. General information

NPI: 1336287200
Provider Name (Legal Business Name): MOUNTAIN COMMUNITIES HEALTHCARE DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2007
Last Update Date: 12/11/2019
Certification Date: 12/11/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 EASTER AVENUE
WEAVERVILLE CA
96093
US

IV. Provider business mailing address

PO BOX 1229
WEAVERVILLE CA
96093-1229
US

V. Phone/Fax

Practice location:
  • Phone: 530-623-5541
  • Fax: 530-623-3920
Mailing address:
  • Phone: 530-623-5541
  • Fax: 530-623-3920

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336I0012X
TaxonomyInstitutional Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License NumberHPE36008
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

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