Healthcare Provider Details

I. General information

NPI: 1588801450
Provider Name (Legal Business Name): COUNTY OF LASSEN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/14/2009
Last Update Date: 02/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 CHESTNUT ST SUITE A
SUSANVILLE CA
96130-3795
US

IV. Provider business mailing address

1400 CHESTNUT ST SUITE A
SUSANVILLE CA
96130-3795
US

V. Phone/Fax

Practice location:
  • Phone: 530-251-2610
  • Fax: 530-252-2670
Mailing address:
  • Phone: 530-251-8108
  • Fax: 530-251-8070

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251T00000X
TaxonomyPACE Provider Organization
License Number
License Number State

VIII. Authorized Official

Name: MR. PERRI YVONNE SMITH
Title or Position: HEALTH & SOCIAL SERVICES CHIEF FISC
Credential:
Phone: 530-251-8255