Provider Demographics
NPI:1477667384
Name:FRONTIER VILLAGE FAMILY HEALTH CENTER, INC
Entity type:Organization
Organization Name:FRONTIER VILLAGE FAMILY HEALTH CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JAGRAJ
Authorized Official - Middle Name:S
Authorized Official - Last Name:NIJJAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:530-528-7650
Mailing Address - Street 1:645 ANTELOPE BLVD STE 24
Mailing Address - Street 2:
Mailing Address - City:RED BLUFF
Mailing Address - State:CA
Mailing Address - Zip Code:96080-2463
Mailing Address - Country:US
Mailing Address - Phone:530-528-7650
Mailing Address - Fax:530-528-7655
Practice Address - Street 1:645 ANTELOPE BLVD STE 24
Practice Address - Street 2:
Practice Address - City:RED BLUFF
Practice Address - State:CA
Practice Address - Zip Code:96080-2463
Practice Address - Country:US
Practice Address - Phone:530-528-7650
Practice Address - Fax:530-528-7655
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-18
Last Update Date:2014-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARHM53909GMedicaid
CARHM53909GMedicaid
CAFO642AMedicare PIN