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General NPI Number Information
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NPI Number | 1093892275
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Entity Type | Organization
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Legal Business Name | SISKIYOU HOSPITAL, INC.
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Dates
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Enumeration Date | 11/01/2006
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Last Update Date | 12/14/2015
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Provider Practice Location Address
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Address Line | 444 BRUCE ST
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City | YREKA
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State | CA
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Zip | 96097-3450
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Country | US
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Telephone | 530-842-4121
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Fax | 530-841-6242
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Provider Business Mailing Address
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Address Line | 444 BRUCE ST
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City | YREKA
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State | CA
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Zip | 96097-3450
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Country | US
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Telephone | 530-842-4121
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Fax | 530-841-6242
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Authorized Official
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Title or Position | CHEIF EXECUTIVE OFFICER
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Name | MR. JONATHON C ANDRUS
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Credential | CEO
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Telephone | 530-841-6200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 230000035
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 261QR1300X
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Taxonomy Name | Rural Health Clinic/Center
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License Number | 230000035
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 275N00000X
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Taxonomy Name | Medicare Defined Swing Bed Hospital Unit
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License Number | 230000035
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License Number State | CA
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Taxonomy #4
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Taxonomy Code | 282NC0060X
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Taxonomy Name | Critical Access Hospital
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License Number | 230000035
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License Number State | CA
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