MEDICARE: SISKIYOU COMMUNITY HEALTH CENTER, INC

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	261QF0400X	Federally Qualified Health Center (FQHC)	127725	OR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1427046903
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SISKIYOU COMMUNITY HEALTH CENTER, INC

Provider Business Mailing Address
First Line	:	1701 NW HAWTHORNE AVE
Second Line	:
City	:	GRANTS PASS
State	:	OR
Zip	:	97526-1051
Country	:	US
Telephone Number	:	541-472-4777
Fax Number	:	541-471-1439

Provider Business Practice Location Address
First Line	:	1701 NW HAWTHORNE AVE
Second Line	:
City	:	GRANTS PASS
State	:	OR
Zip	:	97526-1051
Country	:	US
Telephone Number	:	541-472-4777
Fax Number	:	541-471-1439

Authorized Official
Title or Position	:	CHIEF EXECUTIVE OFFICER
Name	:	ERIC VAN HOUTEN
Credential	:	MSW, MBA
Telephone Number	:	541-472-4777

Provider Enumeration Date	:	10/10/2005
Last Update Date	:	07/02/2025

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Directions to “SISKIYOU COMMUNITY HEALTH CENTER, INC ” Practice Location

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