=====================================================
General NPI Number Information
=====================================================
NPI Number | 1548265069
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | YOUR NEIGHBORHOOD HEALTH CLINIC, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/21/2005
-----------------------------------------------------
Last Update Date | 03/04/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3330 CHURN CREEK RD STE D1
-----------------------------------------------------
City | REDDING
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 96002-2532
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 530-222-9643
-----------------------------------------------------
Fax | 530-222-9602
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3330 CHURN CREEEK ROAD SUITE D1
-----------------------------------------------------
City | REDDING
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 96002
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 530-222-9643
-----------------------------------------------------
Fax | 530-222-9602
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICE MANAGER
-----------------------------------------------------
Name | MS. MICHELE GIBSON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 530-222-9643
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------