Provider Demographics
NPI:1184957771
Name:SOUTH COUNTY COMMUNITY HEALTH CENTER, INC.
Entity type:Organization
Organization Name:SOUTH COUNTY COMMUNITY HEALTH CENTER, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:LUISA
Authorized Official - Middle Name:M
Authorized Official - Last Name:BUADA
Authorized Official - Suffix:
Authorized Official - Credentials:RN, MPH
Authorized Official - Phone:650-330-7410
Mailing Address - Street 1:1885 BAY RD
Mailing Address - Street 2:
Mailing Address - City:EAST PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94303-1312
Mailing Address - Country:US
Mailing Address - Phone:650-330-7410
Mailing Address - Fax:650-321-1156
Practice Address - Street 1:1807 BAY ROAD
Practice Address - Street 2:
Practice Address - City:EAST PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94303-1312
Practice Address - Country:US
Practice Address - Phone:650-330-7407
Practice Address - Fax:650-321-1560
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-14
Last Update Date:2015-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAPPLIED FOR261QF0400X, 261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
No261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)