Healthcare Provider Details

I. General information

NPI: 1275539793
Provider Name (Legal Business Name): LASSEN INDIAN HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/21/2005
Last Update Date: 12/31/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

795 JOAQUIN ST
SUSANVILLE CA
96130-3628
US

IV. Provider business mailing address

795 JOAQUIN ST
SUSANVILLE CA
96130
US

V. Phone/Fax

Practice location:
  • Phone: 530-257-2542
  • Fax: 530-251-5208
Mailing address:
  • Phone: 530-257-2542
  • Fax: 530-251-5208

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License NumberRN300870
License Number StateCA

VIII. Authorized Official

Name: MRS. DEBRA SOKOL
Title or Position: CLINIC MANAGER
Credential: R.N.
Phone: 530-257-2542