Healthcare Provider Details

I. General information

NPI: 1336367515
Provider Name (Legal Business Name): SOUTHERN HUMBOLDT COMMUNITY HEALTHCARE DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2007
Last Update Date: 07/01/2021
Certification Date: 07/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

509 ELM ST
GARBERVILLE CA
95542-3204
US

IV. Provider business mailing address

733 CEDAR ST
GARBERVILLE CA
95542-3201
US

V. Phone/Fax

Practice location:
  • Phone: 707-923-3921
  • Fax: 707-923-1456
Mailing address:
  • Phone: 707-923-3921
  • Fax: 707-923-1456

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number110000052
License Number StateCA

VIII. Authorized Official

Name: SUSAN LEE GARDNER
Title or Position: MED STAFF COORDINATOR
Credential:
Phone: 707-923-3921