Organization
SOUTHERN INDIAN HEALTH COUNCIL
Active
Parent organization
SOUTHERN INDIAN HEALTH COUNCIL INC
Other names
SIHC Kumeyaay Wellness Center
Organization subpart
Yes
Provider details
NPI number
Legal business name
SOUTHERN INDIAN HEALTH COUNCIL INC
Authorized official
MARIE DIZON (LEAD BILLER)
(619) 445-1188
Entity
Organization
Contact information
Practice address
8 CRESTWOOD RD, BOULEVARD, CA 91905-9725
(619) 445-1188
Mailing address
8 CRESTWOOD RD, BOULEVARD, CA 91905-9725
(619) 445-1188
Taxonomy
Speciality
Code
Description
License number
State
261QR0401X
Comprehensive Outpatient Rehabilitation Facility (CORF)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
THP70010F
—
CA
01
—
W7576A
MEDICARE
CA
Enumeration date
11/10/2021
Last updated
11/12/2024
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