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2003 Main St Susanville CA 96130-4501 | |
| (530) 257-6616 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 2003 Main St, Susanville, California |
| Authorized Official Name and Position | Melody King (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 5302833330 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
2003 Main St Susanville CA 96130-4501 Ph: (530) 257-6616 | 2003 Main St Susanville CA 96130-4501 Ph: (530) 257-6616 |
| NPI Number | 1972121762 |
|---|---|
| Provider Enumeration Date | 07/08/2020 |
| Last Update Date | 12/09/2024 |
| Certification Date | 12/09/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1972121762 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
| 251X00000X | Supports Brokerage | (* (Not Available)) | Secondary |
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