Organization
SOUTHERN TRINITY HEALTH INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GRAYLAN LUPTON (CHIEF EXECUTIVE OFFICER)
(707) 574-6616
Entity
Organization
Contact information
Practice address
153-A VAN DUZEN RD, MAD RIVER, CA 95552
(707) 574-6616
(707) 574-6523
Mailing address
PO BOX 7, SCOTIA, CA 95565-0007
(707) 764-5617
(707) 783-5618
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
EAP70040F
—
CA
Enumeration date
12/18/2007
Last updated
04/21/2022
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