Provider Demographics
NPI:1740043231
Name:COUNTY OF SISKIYOU
Entity type:Organization
Organization Name:COUNTY OF SISKIYOU
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF PUBLIC HEALTH, DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SHELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:MN BSN-RN PHN CCHP
Authorized Official - Phone:530-841-2140
Mailing Address - Street 1:810 S MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:YREKA
Mailing Address - State:CA
Mailing Address - Zip Code:96097
Mailing Address - Country:US
Mailing Address - Phone:530-841-2134
Mailing Address - Fax:530-841-4092
Practice Address - Street 1:315 S. OREGON STREET
Practice Address - Street 2:
Practice Address - City:YREKA
Practice Address - State:CA
Practice Address - Zip Code:96097
Practice Address - Country:US
Practice Address - Phone:530-842-8157
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COUNTY OF SISKIYOU
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-02-06
Last Update Date:2025-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare