Mountain Valleys Health Centers
Organization Active NPI Federally Qualified Health Center (FQHC) · Weed, CA
NPI 1073018305 · NPPES record last updated Jul 28, 2023
Key facts
- NPI
- 1073018305
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Federally Qualified Health Center (FQHC) 261QF0400X
- Legal business name
- MOUNTAIN VALLEYS HEALTH CENTERS
- Practice address
- 50 Alamo Ave
Weed, CA 96094-2352 - Phone
- (530) 999-9050
- Fax
- (530) 938-2662
- NPI assigned
- Mar 28, 2018
- Organization subpart
- No
Authorized official
- Name
- Brandon Watkins
- Title
- Cfo
- Phone
- (530) 999-9010
Other NPIs on the same Medicare enrollment 9
Other NPIs with the same Medicare PAC ID 8
Corporate family (same tax ID) 7
Practitioners 38
-
Alan Cohn, M.D.
-
Samuel Cook, MD
-
Lindsay Frye, DO
-
Megan Hoy, NP
-
Thelma Renee Wadsworth, PA-C, RDH
-
Laneah Lynn Snyder, M.D.
-
Joshua Kure, PA-C
-
Michael Akas, NP
-
Aaron C Babb, MD
-
Ryan Scott Carlson, NP-C
-
Amy Nicholene Chambers, LMFT
-
Julie Fadness, FNP
-
Robert Louis Greve, D.C.
-
Mark F Minder, LCSW
-
Karndeep Samran, MD
-
Happy Star Shaw, FNP
-
Gail Leanne Watkins, P.A.-C
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in CA
Federally qualified health center certification: CCN 921069
- Legal name
- MOUNTAIN VALLEYS HEALTH CENTERS
- Doing business as
- WEED HEALTH CENTER
- Certification status
- Active
- Provider type (POS)
- Federally qualified health center
- Participating since
- Apr 24, 2018
- Last certification
- Apr 24, 2018
- Ownership / control type
- For profit – corporation
- Organization structure
- Corporation · Non-profit
- Incorporated
- Jan 16, 1981 in CA
- Enrollment address
- 50 Alamo Ave
Weed, CA 96094-2352
All disclosed owners & managing parties 14
| Name | Role | Since | Share |
|---|---|---|---|
| Jana Blevins |
Corporate Director |
Nov 30, 2020 | |
| Edna Eades |
Corporate Director |
Jul 31, 2017 | |
| Shannon Gerig |
Corporate Officer |
Aug 1, 2019 | |
| W-2 Managing Employee |
Aug 1, 2019 | ||
| Operational/Managerial Control |
Aug 1, 2019 | ||
| John Hayes |
Corporate Director |
Oct 26, 2020 | |
| Susie Lorenzen |
Corporate Director |
Aug 31, 2020 | |
| Connie Voltura |
Corporate Director |
May 28, 2018 | |
| Lydia Hawkins |
W-2 Managing Employee |
Mar 24, 2019 | |
| Becky Vaughan |
Corporate Director |
Feb 27, 2023 | |
| William James Billo |
Corporate Director |
Dec 1, 2016 | |
| Raul Figueroa Tamayo |
Corporate Director |
May 31, 2021 | |
| Brandon Watkins |
Corporate Officer |
Mar 26, 2018 | |
| W-2 Managing Employee |
Mar 26, 2018 | ||
| Operational/Managerial Control |
Mar 26, 2018 | ||
| Edwin Stokes |
Corporate Director |
Nov 30, 2020 | |
| Richard Fuentes |
Corporate Director |
Jan 5, 2011 | |
| Charlene Burgi |
Corporate Director |
May 28, 2018 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20050429000424 | CA | Part B Supplier - Clinic/Group Practice | 4284685538 |
Receives reassigned benefits from 52 practitioners 10 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Dorris, CA; Weed, CA; Tulelake, CA; Mount Shasta, CA; Fall River Mills, CA; Burney, CA; Bieber, CA |
| O20180531001148 | CA | Part a Provider - Federally Qualified Health Center (FQHC) | 4284685538 | Practice locations: Weed, CA |
National Provider Directory
- Tax ID family
- Big Valley Health Cente
Locations
701 Pine St
Mount Shasta, CA 96067
Phone (530) 926-6222
50 Alamo Ave
Weed, CA 96094
Phone (530) 938-3491
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Federally Qualified Health Center (FQHC) | 261QF0400X | Yes |
Addresses
Primary practice location
50 Alamo Ave
Weed, CA 96094-2352
Mailing address
PO Box 277
Bieber, CA 96009-0277
Phone (530) 999-9010
Other names
- Weed Health Center
Other providers in Weed, CA
- Jenna Lynn Henson Marshall
- Theresa Anne Maurer
- Kristin Mercier
- Meridian Health Services Corporation
- Jill C Miller
- Zachary James Myers
- Jeffrey Alexander Ott
- Jaya Ottens
- Laurie Ottens
- Owens Healthcare - Retail Pharmacy, Inc.
All providers in Weed, CA · Federally Qualified Health Center (FQHC) in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 28, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.