MENDOCINO COMMUNITY HEALTH CLINIC, INC. (NPI# 1497961106) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1497961106 |
| Entity Type | Organization |
| Organization Name | MENDOCINO COMMUNITY HEALTH CLINIC, INC. |
| Practice Address |
333 Laws Ave Ukiah CA 95482-6540 |
| Practice Telephone | 7074681010 |
| Practice Fax Number | 7074627078 |
| Mailing Telephone | 7074681010 |
| Mailing Fax Number | 7074627078 |
| Enumeration Date | 2007-05-16 |
| Last Update Date | 2013-03-12 |
| Authorized Official Name | MRS. LINNEA J HUNTER (C.E.O.) |
| Authorized Official Telephone | 7074724511 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 261QF0400X |
Clinic/Center Specialization: Federally Qualified Health Center (FQHC) |
110000360 | CA | Ambulatory Health Care Facilities |
| N | 261QF0400X |
Clinic/Center Specialization: Federally Qualified Health Center (FQHC) |
110000500 | CA | Ambulatory Health Care Facilities |
| Y | 261QF0400X |
Clinic/Center Specialization: Federally Qualified Health Center (FQHC) |
110000236 | CA | Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CA | FHC03933F | 05 | |
| CA | FHC70968F | 05 | |
| CA | FHC70845F | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1356714646 | Mendocino Community Health Clinic, Inc. | Clinic/Center | 1165 S Dora St, Suite A1, Ukiah, CA 95482-8325 | 2015-11-09 |
| 1750809463 | Mendocino Community Health Clinic, Inc. | Clinic/Center | 1165 S Dora St Ste B1, Ukiah, CA 95482-6353 | 2017-09-01 |
| 1922020585 | Mendocino Community Health Clinic, Inc. | Clinic/Center | 45 Hazel St, Willits, CA 95490 | 2006-07-24 |
| 1770516304 | Mendocino Community Health Clinic, Inc. | Clinic/Center | 5335 Lakeshore Blvd, Lakeport, CA 95453-6123 | 2006-07-08 |
| 1811958952 | Mendocino Community Health Clinic, Inc. | Clinic/Center | 333 Laws Ave, Ukiah, CA 95482-6540 | 2006-03-29 |
| Street Address |
333 LAWS AVE |
| City | UKIAH |
| State | CA |
| Zip Code | 95482-6540 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1619970068 | Jorge Anibal Allende Jr. | Internal Medicine | 333 Laws Ave, Ukiah, CA 95482-6540 | 2005-05-31 |
| 1386262921 | Juliann Elizabeth Joseph | Advanced Practice Midwife | 333 Laws Ave, Ukiah, CA 95482-6540 | 2020-07-09 |
| 1164077038 | Neha Sharma | Dentist | 333 Laws Ave, Ukiah, CA 95482-6540 | 2019-08-07 |
| 1053890905 | Liliane Robison | Nurse Practitioner | 333 Laws Ave, Ukiah, CA 95482-6540 | 2018-08-11 |
| 1508356221 | Stuart Christian Mauger | Dentist | 333 Laws Ave, Ukiah, CA 95482-6540 | 2018-05-17 |
| 1831689025 | Kathryn Marie Manchester | Registered Nurse | 333 Laws Ave, Ukiah, CA 95482 | 2018-05-14 |
| 1457855942 | Phuc Cong Tran | Dentist | 333 Laws Ave, Ukiah, CA 95482 | 2018-03-20 |
| 1730600859 | Yesica Jaimes Mendoza | Health Educator | 333 Laws Ave, Ukiah, CA 95482-6540 | 2017-06-28 |
| 1629503727 | Terese O'connell | Dietitian, Registered | 333 Laws Ave, Ukiah, CA 95482-6540 | 2017-04-26 |
| 1821520487 | Connie L Austin | Dentist | 333 Laws Ave, Ukiah, CA 95482-6540 | 2017-03-31 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1932726726 | Gloria Gonzalez Campise | Midwife | 205 W. Clay Street, Ukiah, CA 95482 | 2020-06-29 |
| 1083255095 | Mendocino Care Network | Internal Medicine | 1080 N State St, Ukiah, CA 95482 | 2019-10-01 |
| 1801383153 | Costco Wholesale Corporation | Pharmacy | 1275 Airport Park Blvd., Ukiah, CA 95482 | 2018-04-21 |
| 1922528256 | Ian David Winter | Case Manager/Care Coordinator | 1120 S. Dora St, Ukiah, CA 95482 | 2017-06-27 |
| 1568917938 | Rebecca Ann Dragomani | Nurse Practitioner | 260 Hospital Dr Ste 101, Ukiah, CA 95482 | 2016-08-16 |
| 1811362536 | Manzanita Services, Inc. | Community/Behavioral Health | 410 W. Jones St., Ukiah, CA 95482 | 2015-12-07 |
| 1689061061 | Pamela Mathias | Counselor | 367 East Gobbi Street, Suite E, Ukiah, CA 95482 | 2015-04-23 |
| 1275927030 | Jack David Segel | Counselor | 564 Dora St., Ste.d, Ukiah, CA 95482 | 2015-03-19 |
| 1689070211 | Mendocino County Youth Project | Clinic/Center | 347 Plum St, #b, Ukiah, CA 95482 | 2014-11-10 |
| 1346649951 | Ae Ran Ku | Dentist | 1096 South Dora Street, Ukiah, CA 95482 | 2014-08-19 |
| Find all providers in zip 95482 | ||||
| Taxonomy Code | 261QF0400X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Federally Qualified Health Center (FQHC) |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1356714646 | Mendocino Community Health Clinic, Inc. | Clinic/Center | 1165 S Dora St, Suite A1, Ukiah, CA 95482-8325 | 2015-11-09 |
| 1750809463 | Mendocino Community Health Clinic, Inc. | Clinic/Center | 1165 S Dora St Ste B1, Ukiah, CA 95482-6353 | 2017-09-01 |
| 1811958952 | Mendocino Community Health Clinic, Inc. | Clinic/Center | 333 Laws Ave, Ukiah, CA 95482-6540 | 2006-03-29 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.