| Mountain Health & Community Services, Inc. | |
|
44460 Old Hwy 80 Jacumba CA 91934 | |
| (619) 766-4071 | |
| (619) 766-4128 |
| Full Name | Mountain Health & Community Services, Inc. |
|---|---|
| Speciality | Clinic/center - Federally Qualified Health Center (fqhc) |
| Location | 44460 Old Hwy 80, Jacumba, California |
| Authorized Official Name and Position | Judith Shaplin (CEO) |
| Authorized Official Contact | 6194456200 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Mountain Health & Community Services, Inc. 31115 Highway 94 Campo CA 91906-3133 Ph: (619) 478-5254 | Mountain Health & Community Services, Inc. 44460 Old Hwy 80 Jacumba CA 91934 Ph: (619) 766-4071 |
| NPI Number | 1740358258 |
|---|---|
| Provider Enumeration Date | 12/01/2006 |
| Last Update Date | 10/05/2011 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1740358258 | NPI | - | NPPES |
| FHC53850F | Medicaid | CA | |
| HAP53850F | Other | CA | STATE PROGRAM |
| BCP53850F | Other | CA | STATE PROGRAM |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | 090000511 (California) | Primary |