| Mendonoma Health Alliance | |
|
39251 Ca-1 Gualala CA 95445 | |
| (707) 412-3176 | |
| (707) 412-3196 |
| Full Name | Mendonoma Health Alliance |
|---|---|
| Speciality | Case Management |
| Location | 39251 Ca-1, Gualala, California |
| Authorized Official Name and Position | Micheline Marie White (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 7074123176 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mendonoma Health Alliance Po Box 1196 Gualala CA 95445-1196 Ph: (707) 412-3176 | Mendonoma Health Alliance 39251 Ca-1 Gualala CA 95445 Ph: (707) 412-3176 |
| NPI Number | 1083330807 |
|---|---|
| Provider Enumeration Date | 10/13/2022 |
| Last Update Date | 11/12/2025 |
| Medicare PECOS PAC ID | 8729515515 |
|---|---|
| Medicare Enrollment ID | O20241217004319 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1083330807 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QC1500X | Clinic/center - Community Health | (* (Not Available)) | Secondary |
| 251B00000X | Case Management | (* (Not Available)) | Primary |
| Provider Name | Amelia Randolph |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1093739708 PECOS PAC ID: 8921996240 Enrollment ID: I20170906004008 |
Redwood Coast Medical Services, Inc. Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 46900 Ocean Dr, Gualala, CA 95445 Phone: 707-884-4005 Fax: 707-884-9728 |