NPIMap

Organization Active NPI

Mendocino Coast Clinics, Inc.

  • Federally Qualified Health Center (FQHC)
  • Fort Bragg, CA
National Provider Identifier
1285128595
Registry record updated Jun 20, 2018
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
510 Cypress St Ste C-100
Fort Bragg, CA 95437-5411
Phone
(707) 961-3430
NPI assigned
Jun 20, 2018
Last updated
Jun 20, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 20, 2018

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

Authorized official

Name
Lucresha M 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

510 Cypress St Ste C-100
Fort Bragg, CA 95437-5411

Mailing address

510 Cypress St Ste C-100
Fort Bragg, CA 95437-5411
Phone (707) 961-3430

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA3 enrollments

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
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
O20190909003438 CA Part A Provider - Federally Qualified Health Center (FQHC) 5991619157 1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Fort Bragg, CA
O20250324000272 CA Part A Provider - Federally Qualified Health Center (FQHC) 5991619157 Practice locations: Fort Bragg, CA

NPI to CCN mapping 2

The Medicare certification numbers (CCNs) connected to NPI 1285128595. Details of each certification follow.

Federally qualified health center certification: CCN 921158

Legal name
MENDOCINO COAST CLINICS, INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jul 16, 2019
Last certification
Jul 16, 2019
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Jun 28, 1994 in CA
Enrollment address
101 N Franklin St
Fort Bragg, CA 95437-3602

Federally qualified health center certification: CCN A01948

Legal name
MENDOCINO COAST CLINICS, INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Feb 19, 2025
Last certification
Feb 19, 2025
Ownership / control type
For profit – corporation
Organization structure
OtherNon-profit
Enrollment address
510 Cypress St
Ste C100
Fort Bragg, CA 95437-5411

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 3

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

National Provider Directory

National Provider Directory

Locations

510 Cypress St
Ste C100
Fort Bragg, CA 95437
Phone (707) 961-3430

Ownership & related parties

All disclosed owners & managing parties 19

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

NameRoleSinceShare
Lucresha Renteria Individual Corporate Officer Jan 1, 2016 100%
W-2 Managing Employee Jul 1, 1994
Corporate DirectorCeo Jan 7, 2008 100%
W-2 Managing Employee Jan 7, 2008 100%
Operational/Managerial ControlCeo Jan 7, 2008 100%
Melissa Azevedo Individual Corporate OfficerChair Aug 10, 2021
Matt O'Halloran Individual Corporate DirectorBoard of Director May 10, 2022
Trevor J. Orchard Individual Corporate OfficerSecretary Jul 9, 2019
Corporate Director Jul 9, 2019
Kelly Grimes Individual Corporate OfficerVice Chair Oct 26, 2016
Corporate Director Oct 26, 2016
James Katzel Individual Corporate DirectorBoard of Director Aug 9, 2022
Daphne Haney Individual Corporate OfficerTreasurer Jun 9, 2015
Corporate Director Jun 9, 2015
Rio Parfrey Individual Corporate DirectorBoard of Directors Mar 12, 2019
Corporate Director Mar 12, 2019
Araceli Rivas Individual Corporate DirectorBoard of Directors May 14, 2019
Corporate Director May 14, 2019
Deborah Wyatt Individual Corporate DirectorBoard of Directors May 10, 2022
Yadira Sanchez Individual Corporate DirectorBoard of Directors Jul 11, 2019
Corporate Director Jul 11, 2019
Judith P Waterman Individual Corporate Director Jul 1, 1999
Susan J Peakall Individual Corporate Director Mar 30, 2015
Clare Bercot Zwerling Individual Corporate Director Mar 12, 2019
Claudia Boudreau Individual Corporate Director Nov 23, 2004
Chris Knoerdel Individual Corporate Director Aug 15, 2016
Michelle a Gordon Individual Corporate Director Aug 29, 2016
Meryl Schlingheyde Individual Corporate Director Aug 1, 2016
Christine Kelly Individual Corporate Director Mar 29, 2019

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Practitioners & affiliated clinicians

Practitioners 29

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 29

NPI Registry JSON

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

{
    "created_epoch": "1529452800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1529452800000",
    "number": "1285128595",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "510 CYPRESS ST STE C-100",
            "city": "FORT BRAGG",
            "state": "CA",
            "postal_code": "954375411",
            "telephone_number": "707-961-3430"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "510 CYPRESS ST STE C-100",
            "city": "FORT BRAGG",
            "state": "CA",
            "postal_code": "954375411",
            "telephone_number": "707-961-3430"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MENDOCINO COAST CLINICS, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-06-20",
        "last_updated": "2018-06-20",
        "status": "A",
        "authorized_official_last_name": "RENTERIA",
        "authorized_official_first_name": "LUCRESHA",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "707-964-1251"
    },
    "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.