Southern Trinity Health INC
Clinic/Center, Federally Qualified Health Center (FQHC) in Mad River, CA. Organization (NPI-2).
NPI number1316121007
StatusActive
Last updated in NPPESApr 21, 2022
Details
- NPI
- 1316121007
- Entity type
- Organization (NPI-2)
- Legal business name
- Southern Trinity Health INC
- Organization subpart
- No
- Enumeration date
- Dec 18, 2007
- Certification date
- Apr 21, 2022
- Last updated
- Apr 21, 2022
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 261QF0400X | Clinic/Center, Federally Qualified Health Center (FQHC) | – | – | Yes |
Practice location
153-A Van Duzen RdMad River, CA 95552
Phone 707-574-6616 · Fax 707-574-6523
Mailing address
Po Box 7Scotia, CA 95565-0007
Phone 707-764-5617 · Fax 707-783-5618
Authorized official
Graylan Lupton
Chief Executive Officer
7075746616
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