Organization
WEST COUNTY HEALTH CENTERS, INC.
Active
Other names
Occidental Area Health Center
Organization subpart
No
Provider details
NPI number
Authorized official
MISS TARI M WALLACE (BILLING DIRECTOR)
(707) 869-5977
Entity
Organization
Contact information
Practice address
3802 MAIN STREET, OCCIDENTAL, CA 95464
(707) 874-2444
(707) 874-1664
Mailing address
PO BOX 1449, GUERNEVILLE, CA 95446-1449
(707) 874-2444
(707) 874-1664
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
FHC03899G
—
CA
01
—
HAP03899G
FPACT
CA
01
—
ZZZ23666Z
BLUE SHIELD PIN
CA
Enumeration date
05/31/2005
Last updated
01/23/2008
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