Organization
MOUNTAIN HEALTH & COMMUNITY SERVICES, INC.
Active
Other names
High Desert Family Medicine
Organization subpart
No
Provider details
NPI number
Authorized official
JUDITH SHAPLIN (CEO)
(619) 445-6200
Entity
Organization
Contact information
Practice address
44460 OLD HWY 80, JACUMBA, CA 91934
(619) 766-4071
(619) 766-4128
Mailing address
31115 HIGHWAY 94, CAMPO, CA 91906-3133
(619) 478-5254
(619) 478-9164
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
090000511
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
BCP53850F
STATE PROGRAM
CA
05
—
FHC53850F
—
CA
01
—
HAP53850F
STATE PROGRAM
CA
Enumeration date
12/01/2006
Last updated
10/05/2011
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