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General NPI Number Information
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NPI Number | 1336150051
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Entity Type | Organization
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Legal Business Name | NORTHEASTERN RURAL HEALTH CLINICS
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Dates
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Enumeration Date | 08/10/2006
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Last Update Date | 09/10/2025
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Provider Practice Location Address
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Address Line | 209 BIRCH STREET
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City | WESTWOOD
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State | CA
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Zip | 96137
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Country | US
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Telephone | 530-256-3152
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Fax | 530-256-2061
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Provider Business Mailing Address
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Address Line | 1850 SPRING RIDGE DR
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City | SUSANVILLE
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State | CA
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Zip | 96130-6100
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Country | US
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Telephone | 530-251-5000
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Fax | 530-252-1340
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Authorized Official
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Title or Position | CEO
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Name | LACEY L LIVELY
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Credential |
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Telephone | 530-251-5000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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