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Organization

COLUSA INDIAN COMMUNITY COUNCIL

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MARK SPRAGUE (CLINIC DIRECTOR)
(530) 458-5501
Entity
Organization

Contact information

Practice address
3710 HIGHWAY 45, COLUSA, CA 95932-4026
(530) 458-5501
(530) 458-8660
Mailing address
3710 HIGHWAY 45, COLUSA, CA 95932-4026

Taxonomy

Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary

Other

Enumeration date
09/18/2014
Last updated
09/18/2014
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