MENDOCINO COAST CLINICS INC (NPI# 1083783757) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1083783757 |
| Entity Type | Organization |
| Organization Name | MENDOCINO COAST CLINICS INC |
| Practice Address |
205 South Street Fort Bragg CA 95437-5540 |
| Practice Telephone | 7079641251 |
| Practice Fax Number | 7079612722 |
| Mailing Telephone | 7079641251 |
| Mailing Fax Number | 7079612722 |
| Enumeration Date | 2006-11-07 |
| Last Update Date | 2020-06-09 |
| Authorized Official Name | MS. LUCRESHA RENTERIA (EXECUTIVE DIRECTOR) |
| Authorized Official Telephone | 7079641251 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QF0400X |
Clinic/Center Specialization: Federally Qualified Health Center (FQHC) |
Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CA | FHC03967F | 05 | |
| CA | MEDICARE PART B PTAN | ZZZ15984Z | 01 |
| Street Address |
205 SOUTH STREET |
| City | FORT BRAGG |
| State | CA |
| Zip Code | 95437-5540 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1568594216 | Marcie Mliss Maxham | Dentist | 205 South Street, Fort Bragg, CA 95437-5540 | 2007-03-09 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1902357437 | Mendocino Coast Hospitality Center | Community/Behavioral Health | 137 E. Oak Street, Fort Bragg, CA 95437 | 2016-10-19 |
| 1144604570 | Erin Paul | Community Health Worker | 474 South Franklin Street, Fort Bragg, CA 95437 | 2015-07-15 |
| 1508125790 | Joel Macgregor Green | Marriage & Family Therapist | 331- G Redwood Ave., Fort Bragg, CA 95437 | 2012-05-09 |
| 1013244102 | Jenna Glasscock | Counselor | 331 E Redwood Ave, Ste E, Fort Bragg, CA 95437 | 2009-11-10 |
| 1770819641 | Patrick Lenaghan | Emergency Medicine | 707 River Dr, Fort Bragg, CA 95437 | 2009-10-27 |
| 1043455827 | M. Lee Baker | Dentist | 890 River Dr, Fort Bragg, CA 95437 | 2008-12-09 |
| 1528250495 | Christine Anne Samas | Social Worker | 656a Harrison St., Fort Bragg, CA 95437 | 2007-08-15 |
| 1083822811 | Katharine L. White | Marriage & Family Therapist | 137 E Oak Street, Fort Bragg, CA 95437 | 2007-05-17 |
| 1053525873 | Marty Christine Johnson | Marriage & Family Therapist | 331 E. Redwood Ave, Fort Bragg, CA 95437 | 2007-05-10 |
| 1528114741 | Kate Teresa Donohue | Psychologist | 19201 Noyo Acres Dr, Fort Bragg, CA 95437 | 2007-01-29 |
| Find all providers in zip 95437 | ||||
| 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 |
|---|---|---|---|---|
| 1285128595 | Mendocino Coast Clinics, Inc. | Clinic/Center | 510 Cypress St Ste C-100, Fort Bragg, CA 95437-5411 | 2018-06-20 |
| 1861670093 | Mendocino Coast Clinics, Inc. | Clinic/Center | 855 Sequoia Circle, Fort Bragg, CA 95437-5540 | 2008-02-11 |
| 1326335464 | Mendocino Coast Clinics, Inc | Clinic/Center | 510 Cypress St Ste D, Fort Bragg, CA 95437 | 2011-07-08 |
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| Find all providers with the same taxonomy | ||||
| City | FORT BRAGG |
| Zip Code | 95437 |
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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.