Provider Demographics
NPI:1851691042
Name:CHW MEDICAL FOUNDATION
Entity Type:Organization
Organization Name:CHW MEDICAL FOUNDATION
Other - Org Name:WOODLAND CLINIC, A SERVICE OF CHW MEDICAL FOUNDATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:THERESA
Authorized Official - Middle Name:M
Authorized Official - Last Name:HYLEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-851-2559
Mailing Address - Street 1:1321 COTTONWOOD ST
Mailing Address - Street 2:
Mailing Address - City:WOODLAND
Mailing Address - State:CA
Mailing Address - Zip Code:95695-5131
Mailing Address - Country:US
Mailing Address - Phone:530-668-2600
Mailing Address - Fax:530-666-7255
Practice Address - Street 1:1321 COTTONWOOD ST
Practice Address - Street 2:
Practice Address - City:WOODLAND
Practice Address - State:CA
Practice Address - Zip Code:95695-5131
Practice Address - Country:US
Practice Address - Phone:530-668-2600
Practice Address - Fax:530-666-7255
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHW MEDICAL FOUNDATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-10-22
Last Update Date:2020-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ZZZ52380ZOtherBSCA
CAGR0091675Medicaid
571205856OtherSP TIN
CAZZZ132139ZMedicare PIN