Provider Demographics
NPI:1568905560
Name:SOUTHERN TRINITY HEALTH SERVICES
Entity Type:Organization
Organization Name:SOUTHERN TRINITY HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:GRAYLAN
Authorized Official - Middle Name:
Authorized Official - Last Name:LUPTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:707-764-5617
Mailing Address - Street 1:PO BOX 7
Mailing Address - Street 2:
Mailing Address - City:SCOTIA
Mailing Address - State:CA
Mailing Address - Zip Code:95565-0007
Mailing Address - Country:US
Mailing Address - Phone:707-764-5617
Mailing Address - Fax:707-783-3511
Practice Address - Street 1:500 B STREET SUITE B
Practice Address - Street 2:
Practice Address - City:SCOTIA
Practice Address - State:CA
Practice Address - Zip Code:95565
Practice Address - Country:US
Practice Address - Phone:707-574-6616
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-22
Last Update Date:2022-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)