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NPI Code Detail

MEDICARE: MENDOCINO COAST CLINICS INC

MEDICARE: MENDOCINO COAST CLINICS INC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QF0400XFederally Qualified Health Center (FQHC)

General Provider Information

NPI Number : 1528736022
Entity Type Code : Organization
Provider Name (Legal Business Name) : MENDOCINO COAST CLINICS INC
Provider Business Mailing Address
First Line : 205 SOUTH ST
Second Line :
City : FORT BRAGG
State : CA
Zip : 95437-5540
Country : US
Telephone Number : 707-964-1251
Fax Number : 707-961-2722
Provider Business Practice Location Address
First Line : 101 N FRANKLIN ST
Second Line :
City : FORT BRAGG
State : CA
Zip : 95437-3602
Country : US
Telephone Number : 707-961-0172
Fax Number :
Authorized Official
Title or Position : EXECUTIVE DIRECTOR
Name : LUCRESHA M RENTERIA
Credential :
Telephone Number : 707-964-1251
Provider Enumeration Date : 08/31/2021
Last Update Date : 08/31/2021

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Directions to “MENDOCINO COAST CLINICS INC ” Practice Location

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