Provider Demographics
NPI:1952328403
Name:SHASTA COMMUNITY HEALTH CENTER
Entity Type:Organization
Organization Name:SHASTA COMMUNITY HEALTH CENTER
Other - Org Name:HEALTH OUTREACH FOR PEOPLE EVERYWHERE
Other - Org Type:Other Name
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:DEAN
Authorized Official - Middle Name:C
Authorized Official - Last Name:GERMANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:560-246-5726
Mailing Address - Street 1:PO BOX 992790
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96099-2790
Mailing Address - Country:US
Mailing Address - Phone:530-246-5710
Mailing Address - Fax:530-241-7838
Practice Address - Street 1:1035 PLACER ST
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001-1125
Practice Address - Country:US
Practice Address - Phone:530-246-5710
Practice Address - Fax:530-241-7838
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-17
Last Update Date:2017-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA230000171122300000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No122300000XDental ProvidersDentistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAFHC70418FOtherSCHC-HOPE MEDI-CAL NUMBER
CA75-1909Medicare PIN