Provider Demographics
NPI:1578729380
Name:SONOMA COUNTY INDIAN HEALTH PROJECT, INC
Entity Type:Organization
Organization Name:SONOMA COUNTY INDIAN HEALTH PROJECT, INC
Other - Org Name:SONOMA COUNTY INDIAN HEALTH PROJECT INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:BETTY
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:ARTERBERRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:707-521-4660
Mailing Address - Street 1:144 STONY POINT RD
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95401-4122
Mailing Address - Country:US
Mailing Address - Phone:707-521-4630
Mailing Address - Fax:707-526-1016
Practice Address - Street 1:10A MAMIE LAIWA DRIVE
Practice Address - Street 2:
Practice Address - City:POINT ARENA
Practice Address - State:CA
Practice Address - Zip Code:95468-0623
Practice Address - Country:US
Practice Address - Phone:707-882-2877
Practice Address - Fax:707-882-2880
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-31
Last Update Date:2023-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207Q00000X
CA110000047261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA551807Medicare Oscar/Certification