NPIMap

Organization Active NPI

Mendocino Coast Clinics Inc

  • Federally Qualified Health Center (FQHC)
  • Fort Bragg, CA
National Provider Identifier
1083783757
Registry record updated Jun 9, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
MENDOCINO COAST CLINICS INC
Practice address
205 South Street
Fort Bragg, CA 95437-5540
Phone
(707) 964-1251
Fax
(707) 961-2722
NPI assigned
Nov 7, 2006
Last updated
Jun 9, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 9, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Ms. Lucresha Renteria
Title
Executive Director
Phone
(707) 964-1251

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

205 South Street
Fort Bragg, CA 95437-5540

Mailing address

205 South Street
Fort Bragg, CA 95437-5540
Phone (707) 964-1251

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20031113000226 CA Part A Provider - Federally Qualified Health Center (FQHC) 5991619157 Practice locations: Fort Bragg, CA
O20050512001033 CA Part B Supplier - Clinic/Group Practice 5991619157 Receives reassigned benefits from 34 practitioners
2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Fort Bragg, CA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1083783757. Details of each certification follow.

Federally qualified health center certification: CCN 551813

Legal name
MENDOCINO COAST CLINICS, INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jul 1, 1996
Last certification
Jul 1, 1996
Ownership / control type
For profit – partnership
Organization structure
CorporationNon-profit
Incorporated
Jul 2, 1992 in CA
Enrollment address
205 South St
Fort Bragg, CA 95437-5540

Other NPIs with the same Medicare PAC ID 6

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 2

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
05D0890246Mendocino Coast Clinics205 South St, Fort Bragg, CA 95437Provider-performed microscopySep 9, 2026

National Provider Directory

National Provider Directory

Locations

510 Cypress St
Ste 100
Fort Bragg, CA 95437

510 Cypress St
Ste A
Fort Bragg, CA 95437
Phone (707) 961-1037

1300 National Dr
Ste 175
Sacramento, CA 95834

Ownership & related parties

All disclosed owners & managing parties 15

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Judith P Waterman Individual Corporate OfficerChief Finance Officer Jul 1, 1999
Lucresha Renteria Individual Corporate OfficerCeo Jan 1, 2016 100%
W-2 Managing Employee Jul 1, 1994
Susan J Peakall Individual Corporate OfficerExecutive Assistant Mar 30, 2015
Clare Bercot Zwerling Individual Corporate DirectorBoard of Directors Mar 12, 2019
Trevor J. Orchard Individual Corporate DirectorVice Chairman Jul 9, 2019
Kelly Grimes Individual Corporate DirectorChair Oct 26, 2016
Daphne Haney Individual Corporate DirectorTreasurer Jun 9, 2015
Claudia Boudreau Individual Corporate Director Nov 23, 2004
Chris Knoerdel Individual Corporate DirectorBoard of Director Aug 15, 2016
Rio Parfrey Individual Corporate OfficerSecretary Mar 12, 2019
Araceli Rivas Individual Corporate DirectorBoard of Director May 14, 2019
Yadira Sanchez Individual Corporate DirectorBoard of Director Jul 11, 2019
Michelle a Gordon Individual Corporate OfficerFinance Officer Administration Aug 29, 2016
Meryl Schlingheyde Individual Corporate DirectorChief Operating Officer Aug 1, 2016
Christine Kelly Individual Corporate DirectorBoard of Director Mar 29, 2019

Practitioners & affiliated clinicians

Practitioners 38

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 38

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1162857600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1591660800000",
    "number": "1083783757",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "205 SOUTH STREET",
            "city": "FORT BRAGG",
            "state": "CA",
            "postal_code": "954375540",
            "telephone_number": "707-964-1251",
            "fax_number": "707-961-2722"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "205 SOUTH STREET",
            "city": "FORT BRAGG",
            "state": "CA",
            "postal_code": "954375540",
            "telephone_number": "707-964-1251",
            "fax_number": "707-961-2722"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MENDOCINO COAST CLINICS INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-07",
        "last_updated": "2020-06-09",
        "certification_date": "2020-06-09",
        "status": "A",
        "authorized_official_last_name": "RENTERIA",
        "authorized_official_first_name": "LUCRESHA",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "707-964-1251",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Bragg, CA

Sources for this page

Verify at the official NPI Registry.