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Organization
NORTHEASTERN RURAL HEALTH CLINICS
Active
Organization
NORTHEASTERN RURAL HEALTH CLINICS
Active
Parent organization
NORTHEASTERN HEALTH CENTER
Organization subpart
Yes
Provider details
NPI number
Legal business name
NORTHEASTERN HEALTH CENTER
Authorized official
LACEY L LIVELY (CEO)
(530) 251-5000
Entity
Organization
Contact information
Practice address
1850 SPRING RIDGE DR, SUSANVILLE, CA 96130-6100
(530) 251-5000
(530) 252-1340
Mailing address
1850 SPRING RIDGE DR, SUSANVILLE, CA 96130-6100
(530) 251-5000
(530) 252-1340
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
080005169
RRMCR DOZIER
—
01
—
080042465
RRMCR HOLMES
—
01
—
080061921
RRMCR MORGAN
—
01
—
080119610
RRMCR DAVAINIS
—
05
—
FHC70081F
—
CA
01
—
ZZZ87615Z
BLUE SHIELD
—
Enumeration date
08/09/2006
Last updated
09/10/2025
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