Provider Demographics
NPI:1467180430
Name:SANTA ROSA COMMUNITY HEALTH CENTERS
Entity Type:Organization
Organization Name:SANTA ROSA COMMUNITY HEALTH CENTERS
Other - Org Name:CARITAS CAMPUS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:GABRIELA
Authorized Official - Middle Name:
Authorized Official - Last Name:BERNAL-LEROI
Authorized Official - Suffix:
Authorized Official - Credentials:CEO
Authorized Official - Phone:707-303-3600
Mailing Address - Street 1:3569 ROUND BARN CIRCLE
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95403-5781
Mailing Address - Country:US
Mailing Address - Phone:707-303-3600
Mailing Address - Fax:
Practice Address - Street 1:301 6TH STREET
Practice Address - Street 2:SUITE 214
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95401-9540
Practice Address - Country:US
Practice Address - Phone:707-387-3214
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-09
Last Update Date:2022-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)