MENDOCINO COMMUNITY HEALTH CLINIC, INC. (NPI# 1922020585) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1922020585 |
| Entity Type | Organization |
| Organization Name | MENDOCINO COMMUNITY HEALTH CLINIC, INC. |
| Other Organization Name | LITTLE LAKE HEALTH CENTER |
| Practice Address |
45 Hazel St Willits CA 95490 |
| Mailing Address |
333 Laws Ave Ukiah CA 95482-6540 |
| Practice Telephone | 7074569600 |
| Mailing Telephone | 7074681010 |
| Enumeration Date | 2006-07-24 |
| Last Update Date | 2019-05-03 |
| Authorized Official Name | MR. TIM DOLAN (CFO) |
| Authorized Official Telephone | 7074672260 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 261Q00000X | Clinic/Center | 110000500 | CA | Ambulatory Health Care Facilities |
| Y | 261QF0400X |
Clinic/Center Specialization: Federally Qualified Health Center (FQHC) |
Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CA | FHC70968F | 05 | |
| CA | FAMILYPACT | HAP70968F | 01 |
| Other Name | Type Code |
|---|---|
| Little Lake Health Center | Other Name - Individual/Organization |
| 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 |
| 1497961106 | Mendocino Community Health Clinic, Inc. | Clinic/Center | 333 Laws Ave, Ukiah, CA 95482-6540 | 2007-05-16 |
| 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 |
45 HAZEL ST |
| City | WILLITS |
| State | CA |
| Zip Code | 95490 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1306849674 | Ronald Tholow Zimmerman | Internal Medicine | 45 Hazel St, Willits, CA 95490-4222 | 2005-05-31 |
| 1336630334 | Suzanna Kay Sherer | Family Medicine | 45 Hazel St, Willits, CA 95490-4222 | 2018-05-24 |
| 1003986928 | Larry D Sullivan | Dentist | 45 Hazel St, Willits, CA 95490-4222 | 2006-11-08 |
| 1063482891 | Margaret Lucy Arner | Family Medicine | 45 Hazel St, Willits, CA 95490-4222 | 2006-01-24 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1679194971 | Laisenia Sau | Specialist | 180 E Barbara Lane, Willits, CA 95490 | 2020-04-28 |
| 1588160527 | Redwood Quality Management Company, Inc. | Community/Behavioral Health | 99 S. Humoldt Street #2, Willits, CA 95490 | 2018-03-30 |
| 1497063861 | Daniel Doyle | Audiologist | 474 E. Valley St., Willits, CA 95490 | 2010-09-20 |
| 1659524346 | Erika Littlefawn Tsonetokoy Coyle | Counselor | 110 E Mendocino Ave, Willits, CA 95490 | 2008-10-28 |
| 1912180548 | Paul F Jacobson | Marriage & Family Therapist | 221-b S. Lenore Avenue, Willits, CA 95490 | 2007-12-05 |
| 1629107735 | Mendocino County | Clinic/Center | 474 East Valley Street, Willits, CA 95490 | 2007-03-05 |
| 1821136482 | Jeff A Cramer | Marriage & Family Therapist | 99 East Humboldt Street, Willits, CA 95490 | 2007-02-02 |
| 1215098215 | Esther Judith Faber | Marriage & Family Therapist | 104 W Mendocino Ave, Willits, CA 95490 | 2006-12-13 |
| 1174684492 | Diana E Levy-peart | Chiropractor | 1225 South Main Street, Willits, CA 95490 | 2006-12-12 |
| 1396810628 | Maria Theresa Bates | Social Worker | Maria T Bates Lcsw, 660 So Main St Suite D, Willits, CA 95490 | 2006-11-21 |
| Find all providers in zip 95490 | ||||
| Taxonomy Code | 261QF0400X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Federally Qualified Health Center (FQHC) |
| Definition to come... |
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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.