St Joseph Health Northern California LLC
Doing business as Providence Family Practice
Rural health clinic in Fortuna, CA, Medicare certification number 058698.
Medicare certification
Provider of Services- CCN
- 058698
- Status
- Active
- Provider type
- Rural health clinic
- Control type
- 2B
- Participating since
- Dec 7, 2016
- Last certification
- May 27, 2014
- Most recent change of ownership
- Apr 1, 2018 (1 total)
- Address
- 3302 Renner Drive, Suite a
Fortuna, CA 95540
(707) 725-3318
NPI records for this facility (CCN to NPI Mapping) 1
-
dba Providence Family Practice
- Rural Health Clinic/Center
- Fortuna, CA
- NPI 1194189654
Medicare enrollment
Sources for this page
- Provider of Services: the certification, provider type, beds and status.
- Medicare Care Compare: the star rating and every measure on this page, with the state and national rates CMS publishes beside them.
- NPPES NPI Registry: the NPI records connected to this certification.