Provider Demographics
NPI:1669617783
Name:MOUNTAIN COMMUNITIES HEALTHCARE DISTRICT
Entity type:Organization
Organization Name:MOUNTAIN COMMUNITIES HEALTHCARE DISTRICT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:AARON
Authorized Official - Middle Name:
Authorized Official - Last Name:ROGERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:530-623-2687
Mailing Address - Street 1:PO 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 1:6961 HIGHWAY 3
Practice Address - Street 2:
Practice Address - City:HAYFORK
Practice Address - State:CA
Practice Address - Zip Code:96041-0220
Practice Address - Country:US
Practice Address - Phone:530-628-5517
Practice Address - Fax:530-628-5524
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-03
Last Update Date:2019-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA230000038261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA058646Medicare Oscar/Certification