# BEAR LAKE COMMUNITY HEALTH CENTER, INC.

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Cache Valley Community Health Center, Cache Valley Community Health Center- Providence, Rock Springs Community Health Center, Bear Lake Community Health Center- Montpelier, Bear Lake Community Health Center, Box Elder Community Health Center, Bear Lake Community Health Center- Randolph, Evanston Community Health Center
- **Organization subpart:** No

## Provider details

- **NPI number:** 1629309786
- **Authorized official:** JORGE GARCIA (CEO)
- **Authorized official phone:** (435) 755-6061

## Contact information

- **Practice address:** 325 WEST LOGAN HIGHWAY, GARDEN CITY, UT 84028-8001
- **Practice address phone:** (435) 946-3660
- **Practice address fax:** (435) 946-8215
- **Mailing address:** 517 W 100 N STE 210, PROVIDENCE, UT 84332-9826
- **Mailing address phone:** (435) 755-6061
- **Mailing address fax:** (435) 994-8362

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 104100000X | Social Worker | — | NULL | — |
| 104100000X | Social Worker | — | — | — |
| 106H00000X | Marriage & Family Therapist | — | NULL | — |
| 106H00000X | Marriage & Family Therapist | — | — | — |
| 122300000X | Dentist | — | NULL | — |
| 122300000X | Dentist | — | — | — |
| 1223G0001X | General Practice Dentistry | — | NULL | — |
| 1223G0001X | General Practice Dentistry | — | — | — |
| 133V00000X | Registered Dietitian | — | NULL | — |
| 133V00000X | Registered Dietitian | — | — | — |
| 152W00000X | Optometrist | — | NULL | — |
| 152W00000X | Optometrist | — | — | — |
| 1835P1300X | Psychiatric Pharmacist | — | NULL | — |
| 1835P1300X | Psychiatric Pharmacist | — | — | — |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |
| 207V00000X | Obstetrics & Gynecology Physician | — | NULL | — |
| 207V00000X | Obstetrics & Gynecology Physician | — | — | — |
| 2084P0804X | Child & Adolescent Psychiatry Physician | — | NULL | — |
| 2084P0804X | Child & Adolescent Psychiatry Physician | — | — | — |
| 363A00000X | Physician Assistant | — | NULL | — |
| 363A00000X | Physician Assistant | — | — | — |
| 363L00000X | Nurse Practitioner | — | NULL | — |
| 363L00000X | Nurse Practitioner | — | — | — |
| 363LF0000X | Family Nurse Practitioner | — | NULL | — |
| 363LF0000X | Family Nurse Practitioner | — | — | — |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | NULL | — |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | — | — |

## Other

- **Enumeration date:** 01/28/2010
- **Last updated:** 06/06/2022