MENDOCINO COMMUNITY HEALTH CLINIC INC. NPI 1922020585

NPI Information

  • NPI: 1922020585
  • Provider Name: MENDOCINO COMMUNITY HEALTH CLINIC, INC.
  • Classification: Clinic/Center - 261QF0400X
  • Specialization: Federally Qualified Health Center (FQHC)
  • Entity Type: Organization
  • Other Name: LITTLE LAKE HEALTH CENTER
  • CLIA Number: 05D0856445
  • Address: 45 HAZEL ST
    WILLITS, CA
    ZIP 95490
  • Phone: (707) 456-9600

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NPI Details

MENDOCINO COMMUNITY HEALTH CLINIC, INC. is a federally qualified health center (fqhc) clinic center in Willits, CA. MENDOCINO COMMUNITY HEALTH CLINIC, INC. NPI is 1922020585. The provider is registered as an organization entity type.
The provider Other Name Is Little Lake Health Center.

The provider's business location address is:

45 HAZEL ST
WILLITS, CA
ZIP 95490
Phone: (707) 456-9600

The provider's authorized official is Tim Dolan .
The authorized official title is Cfo and has the following contact phone number (707) 467-2260.

The CLIA number assigned to this NPI record is 05D0856445 - federally qualified health center with a certificate type of Certificate for Provider-Performed Microscopy Procedures (PPMP).

The enumeration date for this NPI number is 7/24/2006 and was last updated on 5/3/2019.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1261Q00000XClinic/Center110000500CALIFORNIANo
2261QF0400XClinic/CenterFederally Qualified Health Center (FQHC)Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1FHC70968FMEDICAIDCALIFORNIA
2HAP70968FOTHERCALIFORNIAFAMILYPACT

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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