Provider Demographics
NPI:1750462271
Name:MOUNTAIN COMMUNITIES HEALTHCARE DISTRICT
Entity Type:Organization
Organization Name:MOUNTAIN COMMUNITIES HEALTHCARE DISTRICT
Other - Org Name:TRINITY HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF REVENUE CYCLE
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:SIMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:530-623-5541
Mailing Address - Street 1:P.O. BOX 1229
Mailing Address - Street 2:
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:530-623-3920
Practice Address - Street 1:60 EASTER AVENUE
Practice Address - Street 2:
Practice Address - City:WEAVERVILLE
Practice Address - State:CA
Practice Address - Zip Code:96093-1229
Practice Address - Country:US
Practice Address - Phone:530-623-5541
Practice Address - Fax:530-623-3920
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-18
Last Update Date:2022-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA230000038251E00000X, 261QR1300X, 282NC0060X, 314000000X
3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
No251E00000XAgenciesHome Health
No261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHSP30392HMedicaid
CAHSP40392HMedicaid
CAHSP40392HMedicaid
CAHSP30392HMedicaid
CA057713Medicare Oscar/Certification
CA055923Medicare Oscar/Certification