Organization
SISKIYOU COMMUNITY HEALTH CENTER, INC.
Active
Parent organization
SISKIYOU COMMUNITY HEALTH CENTER INC
Other names
Lorna Byrne Middle School SBHC
Organization subpart
Yes
Provider details
NPI number
Legal business name
SISKIYOU COMMUNITY HEALTH CENTER INC
Authorized official
RICHARD BOOTH (CEO)
(541) 471-3455
Entity
Organization
Contact information
Practice address
101 S JUNCTION AVE, CAVE JUNCTION, OR 97523-9006
(541) 592-6978
(541) 592-6702
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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