Provider Demographics
NPI:1336150051
Name:NORTHEASTERN RURAL HEALTH CLINICS
Entity Type:Organization
Organization Name:NORTHEASTERN RURAL HEALTH CLINICS
Other - Org Name:WESTWOOD FAMILY PRACTICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHAUB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:530-251-1424
Mailing Address - Street 1:1850 SPRING RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:SUSANVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:96130-6100
Mailing Address - Country:US
Mailing Address - Phone:530-251-1427
Mailing Address - Fax:530-252-1340
Practice Address - Street 1:209 BIRCH STREET
Practice Address - Street 2:
Practice Address - City:WESTWOOD
Practice Address - State:CA
Practice Address - Zip Code:96137
Practice Address - Country:US
Practice Address - Phone:530-256-3152
Practice Address - Fax:530-256-2061
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NORTHEASTERN RURAL HEALTH CLINICS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-10
Last Update Date:2020-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAFHC70292FMedicaid
CAZZZ95961ZOtherBLUE SHIELD
CAFHC70292FMedicaid
CAFHC70292FMedicaid