Organization
SUSANVILLE INDIAN RANCHERIA
Active
Organization
SUSANVILLE INDIAN RANCHERIA
Active
Other names
Lassen Indian Health Center
Organization subpart
No
Provider details
NPI number
Authorized official
LONA MARIE MARIONEAUX IBANITORU (CEO)
(530) 251-5184
Entity
Organization
Contact information
Practice address
795 JOAQUIN ST, SUSANVILLE, CA 96130-3628
(530) 257-2542
(530) 257-1101
Mailing address
795 JOAQUIN ST, SUSANVILLE, CA 96130-3628
(530) 257-2542
(530) 257-1101
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
230000120
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
PHA470460
—
CA
05
—
THP03876F
—
CA
Enumeration date
11/14/2005
Last updated
02/18/2026
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