Organization
MOUNTAIN HEALTH & COMMUNITY SERVICES, INC.
Active
Other names
25th Street Family Medicine
Organization subpart
No
Provider details
NPI number
Authorized official
JUDITH SHAPLIN (CEO)
(619) 445-6200
Entity
Organization
Contact information
Practice address
316 25TH ST, SAN DIEGO, CA 92102-3016
(619) 238-5551
(619) 238-3807
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
550000543
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
BCP71185F
STATE PROGRAM
CA
05
—
FHC71185F
—
CA
01
—
HAP71185F
STATE PROGRAM
CA
Enumeration date
05/25/2007
Last updated
05/08/2017
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