Provider Demographics
NPI:1699216622
Name:OPERATION SAMAHAN, INC.
Entity Type:Organization
Organization Name:OPERATION SAMAHAN, INC.
Other - Org Name:RANCHO PENASQUITOS COMMUNITY HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/CMO
Authorized Official - Prefix:
Authorized Official - First Name:ARCHIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BELLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:844-200-2426
Mailing Address - Street 1:1428 HIGHLAND AVENUE
Mailing Address - Street 2:
Mailing Address - City:NATIONAL CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91950-4624
Mailing Address - Country:US
Mailing Address - Phone:844-200-2426
Mailing Address - Fax:619-356-2726
Practice Address - Street 1:9995 CARMEL MOUNTAIN RD SUITE B10 B11
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92129-4417
Practice Address - Country:US
Practice Address - Phone:844-200-2426
Practice Address - Fax:619-356-2726
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-09
Last Update Date:2022-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
No261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA751021Medicare PIN