Organization
SISKIYOU COMMUNITY HEALTH CENTER, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RICHARD BOOTH (CEO)
(541) 471-3455
Entity
Organization
Contact information
Practice address
625 E RIVER ST, CAVE JUNCTION, OR 97523-9382
(541) 592-3749
(541) 592-3749
Mailing address
1701 NW HAWTHORNE AVE, GRANTS PASS, OR 97526-1051
(541) 471-3455
(541) 471-9242
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
127725
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
127725
—
OR
Enumeration date
01/23/2009
Last updated
10/06/2021
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