Provider Demographics
NPI:1487011847
Name:MOUNTAIN HEALTH & COMMUNITY SERVICES, INC.
Entity Type:Organization
Organization Name:MOUNTAIN HEALTH & COMMUNITY SERVICES, INC.
Other - Org Name:COMMUNITY HEIGHTS FAMILY MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JUDITH
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAPLIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-445-6200
Mailing Address - Street 1:31115 HIGHWAY 94
Mailing Address - Street 2:
Mailing Address - City:CAMPO
Mailing Address - State:CA
Mailing Address - Zip Code:91906-3133
Mailing Address - Country:US
Mailing Address - Phone:619-445-6200
Mailing Address - Fax:619-320-3347
Practice Address - Street 1:4690 EL CAJON BLVD
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92115-4403
Practice Address - Country:US
Practice Address - Phone:619-445-6200
Practice Address - Fax:619-320-3347
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-15
Last Update Date:2017-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACB213153Medicare Oscar/Certification
CA751923Medicare Oscar/Certification