Healthcare Provider Details

I. General information

NPI: 1689742215
Provider Name (Legal Business Name): SANTA ROSA COMMUNITY HEALTH CENTERS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2006
Last Update Date: 05/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

684 BENECIA DRIVE
SANTA ROSA CA
95409-3058
US

IV. Provider business mailing address

3569 ROUND BARN CIRCLE
SANTA ROSA CA
95403-5781
US

V. Phone/Fax

Practice location:
  • Phone: 707-573-4565
  • Fax: 707-576-6687
Mailing address:
  • Phone: 707-303-3600
  • Fax: 707-303-3635

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number070000491
License Number StateCA

VIII. Authorized Official

Name: MS. NAOMI FUCHS
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 707-303-3091