Healthcare Provider Details

I. General information

NPI: 1952198012
Provider Name (Legal Business Name): SOUTHERN HUMBOLDT COMMUNITY HEALTHCARE DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/22/2025
Last Update Date: 04/22/2025
Certification Date: 04/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

630 9TH ST
FORTUNA CA
95540-2324
US

IV. Provider business mailing address

733 CEDAR ST
GARBERVILLE CA
95542-3201
US

V. Phone/Fax

Practice location:
  • Phone: 707-923-3921
  • Fax:
Mailing address:
  • Phone: 707-923-3921
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: KENT SCOWN
Title or Position: COO
Credential:
Phone: 707-923-3921