Little Lake Health Center

LBN: Mendocino Community Health Clinic, Inc.
Little Lake Health Center is an health care organization with primary practice located at 45 Hazel St , Willits CA 95490. The organization recently has 2 registered licenses in different health care specialties including Ambulatory Health Care Facilities / Clinic/Center, Ambulatory Health Care Facilities / Federally Qualified Health Center (FQHC). Ambulatory Health Care Facilities / Federally Qualified Health Center (FQHC) is the primary health care specialty. Mendocino Community Health Clinic, Inc. can be contacted via phone (707) 456-9600, or through Dolan, Tim via phone (707) 467-2260.

Contact Information

Primary practice address
45 Hazel St Willits CA 95490
Phone: (707) 456-9600
Fax:
Website:
Map and Directions
Authorized official contact:
Name: Dolan, Tim
Phone: (707) 467-2260

Health care specialties

SpecialtyCodeLicense #State
Ambulatory Health Care Facilities / Clinic/Center 261Q00000X 110000500 California
Ambulatory Health Care Facilities / Federally Qualified Health Center (FQHC) 261QF0400X

Profile Details

NPI number 1922020585
LBN Legal business name Mendocino Community Health Clinic, Inc.
DBA Doing business as Little Lake Health Center
Authorized official Dolan, Tim
Entity Organization
Organization subpart 1 No
Enumeration date Jul 24th, 2006
Last updated May 3rd, 2019 - about 6 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1922020585 NPPES
California Other HAP70968F FAMILYPACT
California MEDICAID FHC70968F FAMILYPACT

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