Provider Demographics
NPI:1881711547
Name:CHW MEDICAL FOUNDATION
Entity type:Organization
Organization Name:CHW MEDICAL FOUNDATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:THERESA
Authorized Official - Middle Name:M
Authorized Official - Last Name:HYLEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-851-2559
Mailing Address - Street 1:1321 COTTONWOOD ST
Mailing Address - Street 2:
Mailing Address - City:WOODLAND
Mailing Address - State:CA
Mailing Address - Zip Code:95695-5131
Mailing Address - Country:US
Mailing Address - Phone:530-666-1631
Mailing Address - Fax:530-666-7255
Practice Address - Street 1:239 W COURT ST
Practice Address - Street 2:
Practice Address - City:WOODLAND
Practice Address - State:CA
Practice Address - Zip Code:95695-2900
Practice Address - Country:US
Practice Address - Phone:530-668-2656
Practice Address - Fax:530-662-4527
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHW MEDICAL FOUNDATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-26
Last Update Date:2020-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0091674Medicaid
CAZZZ52383ZOtherBLUE SHIELD
CAGR0013030Medicaid
571205856OtherIRS
CAGR0091674Medicaid
CA476040015Medicare PIN