Organization
WEST COUNTY HEALTH CENTERS, INC.
Active
Other names
Russian River Health Center Building #2
Organization subpart
No
Provider details
NPI number
Authorized official
MISS TARI M WALLACE (BILLING MANAGER)
(707) 869-5977
Entity
Organization
Contact information
Practice address
16312 THIRD STREET, GUERNEVILLE, CA 95446
(707) 869-2933
(707) 869-2663
Mailing address
PO BOX 1449, GUERNEVILLE, CA 95446-1449
(707) 869-2933
(707) 869-2663
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
XXXXXXX
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
FHC70957F
—
CA
Enumeration date
07/21/2006
Last updated
02/28/2008
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