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General NPI Number Information
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NPI Number | 1497961106
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Entity Type | Organization
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Legal Business Name | MENDOCINO COMMUNITY HEALTH CLINIC, INC.
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Dates
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Enumeration Date | 05/16/2007
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Last Update Date | 03/12/2013
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Provider Practice Location Address
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Address Line | 333 LAWS AVE
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City | UKIAH
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State | CA
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Zip | 95482-6540
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Country | US
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Telephone | 707-468-1010
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Fax | 707-462-7078
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Provider Business Mailing Address
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Address Line | 333 LAWS AVE
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City | UKIAH
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State | CA
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Zip | 95482-6540
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Country | US
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Telephone | 707-468-1010
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Fax | 707-462-7078
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Authorized Official
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Title or Position | C.E.O.
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Name | MRS. LINNEA J HUNTER
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Credential |
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Telephone | 707-472-4511
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QF0400X
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Taxonomy Name | Federally Qualified Health Center (FQHC)
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License Number | 110000360
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 261QF0400X
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Taxonomy Name | Federally Qualified Health Center (FQHC)
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License Number | 110000500
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 261QF0400X
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Taxonomy Name | Federally Qualified Health Center (FQHC)
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License Number | 110000236
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License Number State | CA
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