NPIMap

Organization Active NPI

Mountain Communities Healthcare District

Doing business as Hayfork Community Health Clinic

  • Rural Health Clinic/Center
  • Hayfork, CA
National Provider Identifier
1669617783
Registry record updated Dec 11, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
License
230000038 Issued in CA
Legal business name
MOUNTAIN COMMUNITIES HEALTHCARE DISTRICT
Doing business as
Hayfork Community Health Clinic
Practice address
6961 Highway 3
Hayfork, CA 96041-0220
Phone
(530) 628-5517
Fax
(530) 628-5524
NPI assigned
Dec 3, 2008
Last updated
Dec 11, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 11, 2019

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

Authorized official

Name
Mr. Aaron Rogers
Title
Chief Executive Officer
Phone
(530) 623-2687

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X 230000038 CA Primary

Addresses

Primary practice location

6961 Highway 3
Hayfork, CA 96041-0220

Mailing address

PO Box 1229
Weaverville, CA 96093-1229
Phone (530) 623-5541

Other names 1

  • Hayfork Community Health Clinic Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20070613000853 CA Part A Provider - Rural Health Clinic 9133227135 1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Weaverville, CA
O20091110000791 CA Part A Provider - Rural Health Clinic 9133227135 Practice locations: Hayfork, CA

NPI to CCN mapping 2

The Medicare certification numbers (CCNs) connected to NPI 1669617783. Details of each certification follow.

Rural health clinic certification: CCN 058618

Legal name
MOUNTAIN COMMUNITIES HEALTHCARE DISTRICT
Doing business as
TRINITY COMMUNITY HEALTH CLINIC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Apr 6, 2006
Last certification
Aug 29, 2018
Ownership / control type
Non-profit – church related
Most recent change of ownership
Jul 1, 2007 (1 total)
Organization structure
OtherProprietary
Incorporated
Aug 10, 2007 in CA
Enrollment address
31 Easter Ave
Weaverville, CA 96093-1229
Related CCNs
051315

Rural health clinic certification: CCN 058646

Legal name
MOUNTAIN COMMUNITIES HEALTHCARE DISTRICT
Doing business as
HAYFORK COMMUNITY HEALTH CLINIC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Jun 24, 2009
Last certification
Apr 4, 2019
Ownership / control type
Non-profit – church related
Organization structure
GovernmentNon-profit
Enrollment address
6961 State Highway 3
Hayfork, CA 96041
Related CCNs
051315

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 3

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

Other NPIs on the same Medicare enrollment 1

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
05D0941735Hayfork Community Health Clinic6961 Highway 3, Hayfork, CA 96041Certificate of waiverMar 1, 2028

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 9

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

NameRoleSinceShare
Kelly J Simpson Individual W-2 Managing EmployeeDirector of Revenue Cycle Nov 9, 2009
W-2 Managing EmployeeManager of Business Services Nov 9, 2009
Paul Hauser Individual Corporate Director May 30, 2018
Corporate Director Jun 1, 2018
Aaron Rogers Individual W-2 Managing EmployeeChief Executive Officer Feb 10, 2015
Corporate OfficerChief Executive Officer Feb 10, 2015
Sheree Beans Individual Corporate Director Mar 25, 2019
Paul Catanese Individual Corporate Director Dec 31, 2018
Bettina Blackwell Individual Corporate Director Jul 25, 2018
Jennifer Flint Individual Corporate Director Feb 27, 2023
Dero Forslund Individual Corporate Director Dec 3, 2014
Mountain Communities Healthcare District Organization, Hayfork, CA Operational/Managerial Control Dec 31, 2008 100%

Owners & managing parties with NPI records 3

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

All facility ownership & control disclosures 2

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Trinity Hospital Swing BedWeaverville, CA, CCN 05Z315 Hospital Operational/Managerial Control Jul 1, 2007
Trinity Hospital Skilled Nursing FacilityWeaverville, CA, CCN 555907 Skilled nursing facility Operational/Managerial Control Jan 26, 2017

Owned or controlled facilities with NPI records 2

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Facilities with the same owner 2

Facilities that share an organizational owner with 5% or greater ownership or operational control.

NPI Registry JSON

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

{
    "created_epoch": "1228262400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1576022400000",
    "number": "1669617783",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1229",
            "city": "WEAVERVILLE",
            "state": "CA",
            "postal_code": "960931229",
            "telephone_number": "530-623-5541",
            "fax_number": "530-623-3920"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6961 HIGHWAY 3",
            "city": "HAYFORK",
            "state": "CA",
            "postal_code": "960410220",
            "telephone_number": "530-628-5517",
            "fax_number": "530-628-5524"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOUNTAIN COMMUNITIES HEALTHCARE DISTRICT",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-12-03",
        "last_updated": "2019-12-11",
        "certification_date": "2019-12-11",
        "status": "A",
        "authorized_official_last_name": "ROGERS",
        "authorized_official_first_name": "AARON",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "530-623-2687",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "CA",
            "license": "230000038",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Hayfork Community Health Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Hayfork Community Health Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Hayfork, CA

Sources for this page

Verify at the official NPI Registry.