Organization
MENDOCINO COMMUNITY HEALTH CLINIC, INC.
Active
Other names
Lakeside Health Center
Organization subpart
No
Provider details
NPI number
Authorized official
MR. TIM DOLAN (CFO)
(707) 467-2260
Entity
Organization
Contact information
Practice address
5335 LAKESHORE BLVD, LAKEPORT, CA 95453-6123
(707) 263-7725
Mailing address
333 LAWS AVE, UKIAH, CA 95482-6540
(707) 468-1010
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
110000350
CA
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
FHC70845F
—
CA
01
—
HAP70845F
FAMILYPACT
CA
Enumeration date
07/08/2006
Last updated
05/03/2019
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