Organization
SISKIYOU COMMUNITY HEALTH CENTER INC
Active
Other names
Siskiyou Community Health Center Dental Facility
Organization subpart
No
Provider details
NPI number
Authorized official
ERIC VAN HOUTEN MSW, MBA (CEO)
(541) 472-4777
Entity
Organization
Contact information
Practice address
1701 NW HAWTHORNE AVE, GRANTS PASS, OR 97526-1051
(541) 479-6393
(541) 479-6489
Mailing address
1701 NW HAWTHORNE AVE, GRANTS PASS, OR 97526-1051
(541) 479-6393
(541) 472-4701
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
—
—
124Q00000X
Dental Hygienist
H3448
OR
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
127725
—
OR
Enumeration date
04/30/2008
Last updated
06/30/2026
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