| Little Lake Health Center | |
|
45 Hazel St Willits CA 95490 | |
| (707) 456-9600 | |
| Not Available |
| Full Name | Little Lake Health Center |
|---|---|
| Speciality | Clinic/Center |
| Location | 45 Hazel St, Willits, California |
| Authorized Official Name and Position | Tim Dolan (CFO) |
| Authorized Official Contact | 7074672260 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Little Lake Health Center 333 Laws Ave Ukiah CA 95482-6540 Ph: (707) 468-1010 | Little Lake Health Center 45 Hazel St Willits CA 95490 Ph: (707) 456-9600 |
| NPI Number | 1922020585 |
|---|---|
| Provider Enumeration Date | 07/24/2006 |
| Last Update Date | 05/03/2019 |
| Medicare PECOS PAC ID | 6305755455 |
|---|---|
| Medicare Enrollment ID | O20030331000024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1922020585 | NPI | - | NPPES |
| HAP70968F | Other | CA | FAMILYPACT |
| FHC70968F | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | 110000500 (California) | Secondary |
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
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