Provider Demographics
NPI:1982658142
Name:MOUNTAIN HEALTH & COMMUNITY SERVICES, INC.
Entity Type:Organization
Organization Name:MOUNTAIN HEALTH & COMMUNITY SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
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:619-478-5254
Mailing Address - Fax:619-478-9164
Practice Address - Street 1:1388 BUCKMAN SPRINGS RD
Practice Address - Street 2:
Practice Address - City:CAMPO
Practice Address - State:CA
Practice Address - Zip Code:91906-2028
Practice Address - Country:US
Practice Address - Phone:619-478-5254
Practice Address - Fax:619-478-9164
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-20
Last Update Date:2020-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA05D0671660OtherCLIA NUMBER
CA051090Medicare Oscar/Certification
CA051093Medicare Oscar/Certification
CAW13315BMedicare Oscar/Certification
CA05D0671660OtherCLIA NUMBER