Organization
SHASTA COMMUNITY HEALTH CENTER
Active
Parent organization
SHASTA COMMUNITY HEALTH CENTER
Other names
Shasta Lake Family Health & Dental Center
Organization subpart
Yes
Provider details
NPI number
Legal business name
SHASTA COMMUNITY HEALTH CENTER
Authorized official
MR. JEFFERY BRANDON THORNOCK (CEO)
(530) 246-5074
Entity
Organization
Contact information
Practice address
4215 FRONT ST, SHASTA LAKE, CA 96019-9430
(530) 246-5896
(530) 241-7838
Mailing address
PO BOX 992790, REDDING, CA 96099-2790
(530) 246-5896
(530) 241-7836
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
230000325
CA
207Q00000X
Family Medicine Physician
230000325
CA
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
363AM0700X
Medical Physician Assistant
230000325
CA
363LF0000X
Family Nurse Practitioner
230000325
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
FHC70877F
SCHC-SLC MEDI-CAL NUMBER
CA
Enumeration date
07/13/2006
Last updated
10/16/2024
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