Provider Demographics
NPI:1013931476
Name:SHASTA COMMUNITY HEALTH CENTER
Entity Type:Organization
Organization Name:SHASTA COMMUNITY HEALTH CENTER
Other - Org Name:HAPPY VALLEY FAMILY HEALTH CENTER
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:530-246-5126
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:530-246-5910
Mailing Address - Fax:530-241-7838
Practice Address - Street 1:16300 CLOVERDALE RD
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:CA
Practice Address - Zip Code:96007-8209
Practice Address - Country:US
Practice Address - Phone:530-246-5910
Practice Address - Fax:530-241-7838
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SHASTA COMMUNITY HEALTH CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-27
Last Update Date:2010-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA230000286207Q00000X, 363A00000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAFHC70755FOtherSCHC-HV MEDI-CAL NUMBER
CAFHC70755FOtherSCHC-HV MEDI-CAL NUMBER