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General NPI Number Information
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NPI Number | 1952198012
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Entity Type | Organization
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Legal Business Name | SOUTHERN HUMBOLDT COMMUNITY HEALTHCARE DISTRICT
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Dates
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Enumeration Date | 04/22/2025
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Last Update Date | 04/22/2025
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Provider Practice Location Address
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Address Line | 630 9TH ST
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City | FORTUNA
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State | CA
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Zip | 95540-2324
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Country | US
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Telephone | 707-923-3921
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Fax |
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Provider Business Mailing Address
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Address Line | 733 CEDAR ST
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City | GARBERVILLE
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State | CA
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Zip | 95542-3201
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Country | US
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Telephone | 707-923-3921
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Fax |
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Authorized Official
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Title or Position | COO
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Name | KENT SCOWN
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Credential |
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Telephone | 707-923-3921
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number |
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License Number State |
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