1013931476 NPI number — SHASTA COMMUNITY HEALTH CENTER

Table of content: (NPI 1013931476)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013931476 NPI number — SHASTA COMMUNITY HEALTH CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SHASTA COMMUNITY HEALTH CENTER
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
HAPPY VALLEY FAMILY HEALTH CENTER
Provider Other Organization Name Type Code:
5
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1013931476
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/08/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 992790
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
REDDING
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
96099-2790
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
530-246-5910
Provider Business Mailing Address Fax Number:
530-241-7838

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
16300 CLOVERDALE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ANDERSON
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
96007-8209
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-246-5910
Provider Business Practice Location Address Fax Number:
530-241-7838
Provider Enumeration Date:
07/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
GERMANO
Authorized Official First Name:
DEAN
Authorized Official Middle Name:
C.
Authorized Official Title or Position:
CHIEF EXECUTIVE OFFICER
Authorized Official Telephone Number:
530-246-5126

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  230000286 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363A00000X , with the licence number: 230000286 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363L00000X , with the licence number: 230000286 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: FHC70755F . This is a "SCHC-HV MEDI-CAL NUMBER" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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