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6840 S Center Dr Clearlake CA 95422-8134 | |
(707) 995-1232 | |
(707) 995-7084 |
Full Name | |
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Speciality | Community/behavioral Health |
Location | 6840 S Center Dr, Clearlake, California |
Authorized Official Name and Position | Rose M. Weaver (PROGRAM DIRECTOR) |
Authorized Official Contact | 7079953235 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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6885 Old Hwy 53 Po Box 6470 Clearlake CA 95422 Ph: (707) 995-3235 | 6840 S Center Dr Clearlake CA 95422-8134 Ph: (707) 995-1232 |
NPI Number | 1215125026 |
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Provider Enumeration Date | 10/05/2007 |
Last Update Date | 10/05/2007 |
Identifier | Type | State | Issuer |
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1215125026 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
251S00000X | Community/behavioral Health | 170010AN (California) | Primary |