Organization · Type 2 NPI

Shasta Community Health Center

Federally Qualified Health Center (FQHC) · Shasta Lake, CA

NPI number 1013932797 Active

Practice location

4215 Front St
Shasta Lake, CA 96019-9430

Call (530) 246-5896 Map

Fax (530) 241-7838

Mailing address

PO Box 992790
Redding, CA 96099-2790

Specialties and licenses

Taxonomy	Code	License
Dentist	122300000X	230000325 (CA)
Family Medicine Physician	207Q00000X	230000325 (CA)
Federally Qualified Health Center (FQHC) Primary	261QF0400X	None listed
Medical Physician Assistant	363AM0700X	230000325 (CA)
Family Nurse Practitioner	363LF0000X	230000325 (CA)

Federally Qualified Health Center (FQHC): Definition to come...

5 other providers at this address

Other federally qualified health center (fqhc) providers in Shasta Lake

Redding RancheriaFederally Qualified Health Center (FQHC) Shasta Lake, CA NPI 1831724053

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NPI record

NPI: 1013932797
Entity type: Organization (Type 2)
Issued: Jul 13, 2006
Last updated: Oct 16, 2024
Status: Active
Subpart: Yes of Shasta Community Health Center

Other names

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Shasta Lake Family Health & Dental Center · doing business as

Authorized official

Mr. Jeffery Brandon Thornock
CEO
(530) 246-5074

Verify this record

This page mirrors the public NPPES file. For credentialing or billing, confirm it on the official CMS NPI Registry, and check the license with the state board.

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About NPI 1013932797

Shasta Community Health Center's National Provider Identifier is 1013932797, issued on Jul 13, 2006. The primary taxonomy on file is Federally Qualified Health Center (FQHC) (261QF0400X), and the practice location is in Shasta Lake, CA. The record was last updated on Oct 16, 2024.