Provider Demographics
NPI:1194374413
Name:KAWEAH DELTA HEALTH CARE DISTRICT
Entity Type:Organization
Organization Name:KAWEAH DELTA HEALTH CARE DISTRICT
Other - Org Name:SEQUOIA HEALTH & WELLNESS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SR. VP/CFO
Authorized Official - Prefix:
Authorized Official - First Name:MALINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:TUPPER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-624-4065
Mailing Address - Street 1:400 W MINERAL KING AVE
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93291-6237
Mailing Address - Country:US
Mailing Address - Phone:559-624-2739
Mailing Address - Fax:
Practice Address - Street 1:202 W WILLOW AVE STE 502
Practice Address - Street 2:
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93291-6268
Practice Address - Country:US
Practice Address - Phone:559-624-6590
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KAWEAH DELTA HEALTH CARE DISTRICT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-09-09
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CATBDOtherMEDICARE