Basic Information
| Provider Information | |||||||||
| NPI: | 1811581572 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SOUTHERN HUMBOLDT COMMUNITY HEALTHCARE DISTRICT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 733 CEDAR ST | ||||||||
| Address2: | |||||||||
| City: | GARBERVILLE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 955423201 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7079233921 | ||||||||
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| Practice Location | |||||||||
| Address1: | 286 SPROWEL CREEK RD | ||||||||
| Address2: | |||||||||
| City: | GARBERVILLE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 955423306 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7079217078 | ||||||||
| FaxNumber: | 7079217069 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/23/2021 | ||||||||
| LastUpdateDate: | 02/23/2021 | ||||||||
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| AuthorizedOfficialLastName: | JOHNSON | ||||||||
| AuthorizedOfficialFirstName: | KAREN | ||||||||
| AuthorizedOfficialMiddleName: | R | ||||||||
| AuthorizedOfficialTitleorPosition: | MEDICAL STAFF COORDINATOR | ||||||||
| AuthorizedOfficialTelephone: | 7079233921 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | SOUTHERN HUMBOLDT COMMUNITY HEALTHCARE DISTRICT | ||||||||
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| NPICertificationDate: | 02/23/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 3336C0003X | Y | Suppliers | Pharmacy | Community/Retail Pharmacy |
No ID Information.