Provider Demographics
NPI:1740358258
Name:MOUNTAIN HEALTH & COMMUNITY SERVICES, INC.
Entity type:Organization
Organization Name:MOUNTAIN HEALTH & COMMUNITY SERVICES, INC.
Other - Org Name:<UNAVAIL>
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 1:44460 OLD HWY 80
Practice Address - Street 2:
Practice Address - City:JACUMBA
Practice Address - State:CA
Practice Address - Zip Code:91934
Practice Address - Country:US
Practice Address - Phone:619-766-4071
Practice Address - Fax:619-766-4128
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-01
Last Update Date:2011-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA090000511261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAFHC53850FMedicaid
CAHAP53850FOtherSTATE PROGRAM
CABCP53850FOtherSTATE PROGRAM
CAFHC53850FMedicaid
CAW13315Medicare Oscar/Certification