Provider Demographics
NPI:1235546995
Name:HURTT FAMILY HEALTH CLINIC, INC.
Entity Type:Organization
Organization Name:HURTT FAMILY HEALTH CLINIC, INC.
Other - Org Name:ORANGE COUNTY RESCUE MISSION HEALTH CARE SERVICES, INC.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BECKY
Authorized Official - Middle Name:
Authorized Official - Last Name:CARTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-247-8044
Mailing Address - Street 1:1 HOPE DR
Mailing Address - Street 2:
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92782-0221
Mailing Address - Country:US
Mailing Address - Phone:714-247-0300
Mailing Address - Fax:714-259-1598
Practice Address - Street 1:1 HOPE DR
Practice Address - Street 2:
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92782-0221
Practice Address - Country:US
Practice Address - Phone:714-247-4398
Practice Address - Fax:714-566-6475
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-15
Last Update Date:2019-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA060000772261QC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAEK397AMedicare UPIN
CA551016Medicare PIN