Basic Information
| Provider Information | |||||||||
| NPI: | 1669617783 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | MOUNTAIN COMMUNITIES HEALTHCARE DISTRICT | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | HAYFORK COMMUNITY HEALTH CLINIC | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1229 | ||||||||
| Address2: | |||||||||
| City: | WEAVERVILLE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 960931229 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5306235541 | ||||||||
| FaxNumber: | 5306233920 | ||||||||
| Practice Location | |||||||||
| Address1: | 6961 HIGHWAY 3 | ||||||||
| Address2: | |||||||||
| City: | HAYFORK | ||||||||
| State: | CA | ||||||||
| PostalCode: | 960410220 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5306285517 | ||||||||
| FaxNumber: | 5306285524 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/03/2008 | ||||||||
| LastUpdateDate: | 12/11/2019 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | ROGERS | ||||||||
| AuthorizedOfficialFirstName: | AARON | ||||||||
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| AuthorizedOfficialTitleorPosition: | CHIEF EXECUTIVE OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 5306232687 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| NPICertificationDate: | 12/11/2019 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QR1300X | 230000038 | CA | Y | Ambulatory Health Care Facilities | Clinic/Center | Rural Health |
No ID Information.