Provider Demographics
NPI:1467533000
Name:MOUNTAIN COMMUNITIES HEALTHCARE DIS
Entity Type:Organization
Organization Name:MOUNTAIN COMMUNITIES HEALTHCARE DIS
Other - Org Name:TRINITY COMMUNITY DENTAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR REVENUE CYCLE
Authorized Official - Prefix:MS
Authorized Official - First Name:ALETHEA
Authorized Official - Middle Name:
Authorized Official - Last Name:HIGGINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:530-623-5541
Mailing Address - Street 1:P.O, BOX 1229
Mailing Address - Street 2:60 EASTER AVENUE
Mailing Address - City:WEAVERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:96093-1229
Mailing Address - Country:US
Mailing Address - Phone:530-623-5541
Mailing Address - Fax:530-623-6421
Practice Address - Street 1:121 BARBARA AVENUE
Practice Address - Street 2:
Practice Address - City:WEAVERVILLE
Practice Address - State:CA
Practice Address - Zip Code:96093
Practice Address - Country:US
Practice Address - Phone:530-623-5541
Practice Address - Fax:530-623-6421
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-18
Last Update Date:2013-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA230000038261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARHC08618FMedicaid