Provider Demographics
NPI:1275539793
Name:LASSEN INDIAN HEALTH CENTER
Entity Type:Organization
Organization Name:LASSEN INDIAN HEALTH CENTER
Other - Org Name:SUSANVILLE INDIAN RANCHERIA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINIC MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:
Authorized Official - Last Name:SOKOL
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:530-257-2542
Mailing Address - Street 1:795 JOAQUIN ST
Mailing Address - Street 2:
Mailing Address - City:SUSANVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:96130
Mailing Address - Country:US
Mailing Address - Phone:530-257-2542
Mailing Address - Fax:530-251-5208
Practice Address - Street 1:795 JOAQUIN ST
Practice Address - Street 2:
Practice Address - City:SUSANVILLE
Practice Address - State:CA
Practice Address - Zip Code:96130-3628
Practice Address - Country:US
Practice Address - Phone:530-257-2542
Practice Address - Fax:530-251-5208
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-21
Last Update Date:2009-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN300870261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center