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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