=====================================================
General NPI Number Information
=====================================================
NPI Number | 1497937817
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ALL FAMILY HEALTH CARE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/27/2007
-----------------------------------------------------
Last Update Date | 11/27/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 918 4TH ST
-----------------------------------------------------
City | YREKA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 96097-3314
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 530-842-9184
-----------------------------------------------------
Fax | 530-842-9084
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 918 4TH ST
-----------------------------------------------------
City | YREKA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 96097-3314
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 530-842-9184
-----------------------------------------------------
Fax | 530-842-9084
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MRS. CECILY HELEN SHAW-SCALA
-----------------------------------------------------
Credential | MSN FNP-C
-----------------------------------------------------
Telephone | 530-842-9184
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2300X
-----------------------------------------------------
Taxonomy Name | Primary Care Clinic/Center
-----------------------------------------------------
License Number | 418864
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------