Organization
MCCLOUD HEALTHCARE CLINIC, INC.
Active
Other names
Shasta Cascade Health Centers
Organization subpart
No
Provider details
NPI number
Authorized official
MR. CALEB J OTT (ADMINISTRATOR)
(530) 926-6309
Entity
Organization
Contact information
Practice address
116 W MINNESOTA AVE, MCCLOUD, CA 96057-1143
(530) 964-2389
(530) 964-3141
Mailing address
PO BOX 1143, MCCLOUD, CA 96057-1143
(530) 964-2389
(530) 964-3141
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
550001195
CA
261QR1300X
Rural Health Clinic/Center
553934
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
55-3934
CAHABA GBA
CA
05
—
RHM53934F
—
CA
01
—
ZZZ24754Z
MEDICARE PART B
CA
Enumeration date
06/22/2005
Last updated
03/23/2023
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