Provider Demographics
NPI:1548265069
Name:YOUR NEIGHBORHOOD HEALTH CLINIC, INC
Entity type:Organization
Organization Name:YOUR NEIGHBORHOOD HEALTH CLINIC, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:MICHELE
Authorized Official - Middle Name:
Authorized Official - Last Name:GIBSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:530-222-9643
Mailing Address - Street 1:3330 CHURN CREEEK ROAD
Mailing Address - Street 2:SUITE D1
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96002
Mailing Address - Country:US
Mailing Address - Phone:530-222-9643
Mailing Address - Fax:530-222-9602
Practice Address - Street 1:3330 CHURN CREEK RD
Practice Address - Street 2:STE D1
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96002-2532
Practice Address - Country:US
Practice Address - Phone:530-222-9643
Practice Address - Fax:530-222-9602
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-21
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARN4337340Medicaid
CA00G28035OtherMEDICARE ID
CARN4337340Medicaid
CAZZZ31564ZMedicare PIN
CAP35570Medicare UPIN
CAA47748Medicare UPIN