Provider Demographics
NPI:1073640918
Name:SOUTH COUNTY COMMUNITY HEALTH CENTER, INC.
Entity Type:Organization
Organization Name:SOUTH COUNTY COMMUNITY HEALTH CENTER, INC.
Other - Org Name:RAVENSWOOD FAMILY HEALTH CENTER AT BELLE HAVEN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:WAYNE
Authorized Official - Middle Name:
Authorized Official - Last Name:YOST
Authorized Official - Suffix:
Authorized Official - Credentials:CPA, CFE
Authorized Official - Phone:650-330-7407
Mailing Address - Street 1:1798 A BAY RD
Mailing Address - Street 2:
Mailing Address - City:EAST PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94303-1611
Mailing Address - Country:US
Mailing Address - Phone:650-330-7400
Mailing Address - Fax:650-321-1560
Practice Address - Street 1:100 TERMINAL AVE
Practice Address - Street 2:
Practice Address - City:MENLO PARK
Practice Address - State:CA
Practice Address - Zip Code:94025-1246
Practice Address - Country:US
Practice Address - Phone:650-321-0980
Practice Address - Fax:650-321-0988
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-27
Last Update Date:2008-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care