Organization
LAKE COUNTY TRIBAL HEALTH SOUTHSHORE CLINIC
Active
Parent organization
LAKE COUNTY TRIBAL HEALTH CONSORTIUM INC.
Organization subpart
Yes
Provider details
NPI number
Legal business name
LAKE COUNTY TRIBAL HEALTH CONSORTIUM INC.
Authorized official
MR. ERNESTO PADILLA (CEO)
(707) 263-8382
Entity
Organization
Contact information
Practice address
14440 OLYMPIC DRIVE, CLEARLAKE, CA 95422
(707) 263-8382
(707) 263-5019
Mailing address
PO BOX 1950, LAKEPORT, CA 95453-1950
(707) 263-8382
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Enumeration date
05/11/2022
Last updated
04/02/2024
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