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General NPI Number Information
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NPI Number | 1982413274
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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 | 01/02/2025
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Last Update Date | 01/02/2025
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Provider Practice Location Address
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Address Line | 1165 S DORA ST STE C
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City | UKIAH
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State | CA
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Zip | 95482-8325
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Country | US
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Telephone | 707-468-1010
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Fax |
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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 |
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Authorized Official
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Title or Position | DIRECTOR OF FINANCE
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Name | LAVONNA MARIE SCHROCK
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Credential |
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Telephone | 707-468-2219
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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 |
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License Number State |
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