Organization
MENDOCINO COAST HOSPITALITY CENTER
Active
Other names
Hospitality Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
PAUL MICHAEL DAVIS (EXECUTIVE DIRECTOR)
(707) 941-0408
Entity
Organization
Contact information
Practice address
101 N FRANKLIN STREET, FORT BRAGG, CA 95437
(707) 961-0172
(844) 388-6167
Mailing address
PO BOX 2168, FORT BRAGG, CA 95437
(707) 961-0172
(707) 961-0217
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
23CR
—
CA
Enumeration date
08/20/2013
Last updated
12/19/2024
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