Provider Demographics
NPI:1619005170
Name:BUTTE COUNTY DEPARTMENT OF PUBLIC HEALTH , LABORATORY
Entity Type:Organization
Organization Name:BUTTE COUNTY DEPARTMENT OF PUBLIC HEALTH , LABORATORY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DEANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:BLANKENSHIP
Authorized Official - Suffix:
Authorized Official - Credentials:MPH
Authorized Official - Phone:530-552-3877
Mailing Address - Street 1:202 MIRA LOMA DR
Mailing Address - Street 2:
Mailing Address - City:OROVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95965-3500
Mailing Address - Country:US
Mailing Address - Phone:530-538-7583
Mailing Address - Fax:530-538-2164
Practice Address - Street 1:695 OLEANDER AVE
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95926-3924
Practice Address - Country:US
Practice Address - Phone:530-891-2747
Practice Address - Fax:530-895-6660
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-28
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA0194291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA05D0617090OtherCLIA
CALAB58802FMedicaid