Provider Demographics
NPI:1700882461
Name:SISKIYOU HOME HEALTH SERVICES
Entity Type:Organization
Organization Name:SISKIYOU HOME HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARIJO
Authorized Official - Middle Name:
Authorized Official - Last Name:WELBORN
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:530-842-7325
Mailing Address - Street 1:700 S MAIN ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:YREKA
Mailing Address - State:CA
Mailing Address - Zip Code:96097-3354
Mailing Address - Country:US
Mailing Address - Phone:530-842-7325
Mailing Address - Fax:530-842-1028
Practice Address - Street 1:700 S MAIN ST
Practice Address - Street 2:SUITE 2
Practice Address - City:YREKA
Practice Address - State:CA
Practice Address - Zip Code:96097-3354
Practice Address - Country:US
Practice Address - Phone:530-842-7325
Practice Address - Fax:530-842-1028
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-27
Last Update Date:2015-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHHA07708FCAMedicaid
CAHHA07708FMedicaid
057708Medicare Oscar/Certification
CAHHA07708FCAMedicaid