NPIMap

Organization Active NPI

M a C T Health Board Incorporated

Doing business as MACT Behavioral Health, Valley Springs

  • Federally Qualified Health Center (FQHC)
  • Valley Springs, CA
National Provider Identifier
1649091109
Registry record updated Jun 12, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
M A C T HEALTH BOARD INCORPORATED
Doing business as
MACT Behavioral Health, Valley Springs
Practice address
1906 Vista del Lago Dr Ste K
Valley Springs, CA 95252-9700
Phone
(209) 755-1490
Fax
(209) 459-4054
NPI assigned
Oct 17, 2024
Last updated
Jun 12, 2025By the provider in NPPES
Organization subpart
Yes
Parent organization
M A C T HEALTH BOARD INCORPORATEDAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 12, 2025

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

Authorized official

Name
John Shawver Alexander
Title
Executive Director
Phone
(209) 754-6262

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X NU
Federally Qualified Health Center (FQHC) 261QF0400X NU Primary
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X NU
Community Health Worker 172V00000X NU
Case Manager/Care Coordinator 171M00000X NU

Addresses

Primary practice location

1906 Vista del Lago Dr Ste K
Valley Springs, CA 95252-9700

Mailing address

PO Box 939
Angels Camp, CA 95222-0939
Phone (209) 754-6262

Other names 1

  • MACT Behavioral Health, Valley Springs Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20250225001527 CA Part A Provider - Federally Qualified Health Center (FQHC) 8325936974 1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Valley Springs, CA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1649091109. Details of each certification follow.

Federally qualified health center certification: CCN A01937

Legal name
M A C T HEALTH BOARD INCORPORATED
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Mar 5, 2025
Last certification
Mar 5, 2025
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Enrollment address
1906 Vista del Lago Dr
Ste K
Valley Springs, CA 95252-9700

Other NPIs on the same Medicare enrollment 1

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

National Provider Directory

National Provider Directory
Tax ID family
Mact Health Board Incorporated13 organizations share this tax ID, including this one
Part of
Mact Health Board Incorporated

Other organizations with this tax ID 12

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 6

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

NameRoleSinceShare
Justin Baugh Individual Corporate DirectorBoard Chair Jun 26, 2017
George Gurion Individual Corporate OfficerBoard Vice Chair Apr 22, 2023
Carolyn Sayers Individual Corporate OfficerBoard Secretary Jun 3, 2025
Mariela Contreras Individual Corporate DirectorExecutive Director May 4, 2026
W-2 Managing EmployeeExecutive Director Jul 25, 2015
Nancy Ehlers Individual Corporate OfficerBoard Secretary Jan 21, 2019
M a C T Health Board Incorporated Organization, Angels Camp, CA Corporation, Non-profit 5% Or Greater Direct Ownership Interest Sep 21, 1979 100%

Owners & managing parties with NPI records 6

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

Practitioners & affiliated clinicians

Practitioners 11

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.

NPI Registry JSON

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

{
    "created_epoch": "1729123200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1749686400000",
    "number": "1649091109",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 939",
            "city": "ANGELS CAMP",
            "state": "CA",
            "postal_code": "952220939",
            "telephone_number": "209-754-6262",
            "fax_number": "209-736-1814"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1906 VISTA DEL LAGO DR STE K",
            "city": "VALLEY SPRINGS",
            "state": "CA",
            "postal_code": "952529700",
            "telephone_number": "209-755-1490",
            "fax_number": "209-459-4054"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "M A C T HEALTH BOARD INCORPORATED",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "M A C T HEALTH BOARD INCORPORATED",
        "enumeration_date": "2024-10-17",
        "last_updated": "2025-06-12",
        "certification_date": "2025-06-12",
        "status": "A",
        "authorized_official_last_name": "ALEXANDER",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "SHAWVER",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "209-754-6262"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "172V00000X",
            "taxonomy_group": "",
            "desc": "Community Health Worker",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "171M00000X",
            "taxonomy_group": "",
            "desc": "Case Manager/Care Coordinator",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MACT Behavioral Health, Valley Springs",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "MACT Behavioral Health, Valley Springs",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Valley Springs, CA

Sources for this page

Verify at the official NPI Registry.