Healthcare Provider Details

I. General information

NPI: 1871666412
Provider Name (Legal Business Name): CHURCH OF LOVING HANDS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

639 11TH ST
FORTUNA CA
95540-2346
US

IV. Provider business mailing address

111 ORCHARD AVE
CARLOTTA CA
95528-9733
US

V. Phone/Fax

Practice location:
  • Phone: 707-725-9627
  • Fax: 707-725-2471
Mailing address:
  • Phone: 707-725-9627
  • Fax: 707-725-2471

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberABMP#106753
License Number StateCO

VIII. Authorized Official

Name: DR. ROSALIND SKYHAWK OJALA
Title or Position: ADMINISTRATIVE DIRECTOR
Credential: C.M.T., D.D.
Phone: 707-725-9627