Organization
MENDOCINO COAST CLINICS INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. LUCRESHA RENTERIA (EXECUTIVE DIRECTOR)
(707) 964-1251
Entity
Organization
Contact information
Practice address
205 SOUTH STREET, FORT BRAGG, CA 95437-5540
(707) 964-1251
(707) 961-2722
Mailing address
205 SOUTH STREET, FORT BRAGG, CA 95437-5540
(707) 964-1251
(707) 961-2722
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
FHC03967F
—
CA
01
—
ZZZ15984Z
MEDICARE PART B PTAN
CA
Enumeration date
11/07/2006
Last updated
06/09/2020
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