Healthcare Provider Details

I. General information

NPI: 1679374433
Provider Name (Legal Business Name): FIRST FIVE YUBA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2025
Last Update Date: 03/19/2025
Certification Date: 03/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1114 YUBA ST RM 141
MARYSVILLE CA
95901-4838
US

IV. Provider business mailing address

1114 YUBA ST RM 141
MARYSVILLE CA
95901-4838
US

V. Phone/Fax

Practice location:
  • Phone: 530-749-4877
  • Fax:
Mailing address:
  • Phone: 530-749-4877
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State

VIII. Authorized Official

Name: SARAH KOTKO
Title or Position: PROGRAM COORDINATOR
Credential:
Phone: 530-749-4877