MEDICARE: OROVILLE SOUTHSIDE COMMUNITY IMPROVEMENT ASSOCIATION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1003749300
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OROVILLE SOUTHSIDE COMMUNITY IMPROVEMENT ASSOCIATION

Provider Business Mailing Address
First Line	:	2959 LOWER WYANDOTTE RD
Second Line	:
City	:	OROVILLE
State	:	CA
Zip	:	95966-6201
Country	:	US
Telephone Number	:	530-693-0728
Fax Number	:

Provider Business Practice Location Address
First Line	:	2959 LOWER WYANDOTTE RD
Second Line	:
City	:	OROVILLE
State	:	CA
Zip	:	95966-6201
Country	:	US
Telephone Number	:	530-693-0728
Fax Number	:

Authorized Official
Title or Position	:	CEO/EXECUTIVE DIRECTOR
Name	:	MR. KEVIN THOMPSON
Credential	:
Telephone Number	:	530-693-0728

Provider Enumeration Date	:	06/05/2026
Last Update Date	:	06/05/2026

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