Provider Demographics
NPI:1376626903
Name:ENLOE MEDICAL CENTER
Entity Type:Organization
Organization Name:ENLOE MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR, PFS
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:VENARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:530-332-6331
Mailing Address - Street 1:1531 ESPLANADE
Mailing Address - Street 2:ATTN: FINANCE
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95926-3310
Mailing Address - Country:US
Mailing Address - Phone:530-332-7357
Mailing Address - Fax:530-893-6853
Practice Address - Street 1:1390 E LASSEN AVE
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95973-7823
Practice Address - Country:US
Practice Address - Phone:530-332-7479
Practice Address - Fax:530-893-6853
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ENLOE MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-24
Last Update Date:2023-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA230000081251E00000X
385H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No385H00000XRespite Care FacilityRespite Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHHA07661FMedicaid
CA057661Medicare PIN