Organization
SOUTHERN HUMBOLDT COMMUNITY HEALTHCARE DISTRICT
Active
Other names
Southern Humboldt Community Hospital District, Southern Humboldt Community Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
SUSAN LEE GARDNER (MED STAFF COORDINATOR)
(707) 923-3921
Entity
Organization
Contact information
Practice address
509 ELM ST, GARBERVILLE, CA 95542-3204
(707) 923-3921
(707) 923-1456
Mailing address
733 CEDAR ST, GARBERVILLE, CA 95542-3201
(707) 923-3921
(707) 923-1456
Taxonomy
Speciality
Code
Description
License number
State
261QR1300X
Rural Health Clinic/Center
Primary
110000052
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
174988
—
AZ
05
—
272260
—
OR
05
—
3003993
—
WA
01
—
RHM03921G
MEDI-CAL
CA
01
—
ZZZ05354Z
BLUE SHIELD CLINIC
CA
Enumeration date
04/23/2007
Last updated
07/01/2021
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