Provider Demographics
NPI:1881686301
Name:SISKIYOU FAMILY HEALTHCARE, INC.
Entity Type:Organization
Organization Name:SISKIYOU FAMILY HEALTHCARE, INC.
Other - Org Name:SISKIYOU FAMILY HEALTHCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:BLISS
Authorized Official - Suffix:
Authorized Official - Credentials:PA
Authorized Official - Phone:530-842-3606
Mailing Address - Street 1:PO BOX 1608
Mailing Address - Street 2:
Mailing Address - City:YREKA
Mailing Address - State:CA
Mailing Address - Zip Code:96097-1608
Mailing Address - Country:US
Mailing Address - Phone:530-842-3606
Mailing Address - Fax:530-842-3567
Practice Address - Street 1:700 S MAIN ST
Practice Address - Street 2:
Practice Address - City:YREKA
Practice Address - State:CA
Practice Address - Zip Code:96097-3354
Practice Address - Country:US
Practice Address - Phone:530-842-0817
Practice Address - Fax:530-842-3567
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARHM53948FMedicaid
CARHM53948FMedicaid