Potter Valley Community Health Ctr

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

License

FHC03879F Issued in CA

Legal business name

POTTER VALLEY COMMUNITY HEALTH CTR

Practice address

10175 Main St
Potter Valley, CA 95469-9749

Phone

(707) 743-1188

Fax

(707) 743-1192

NPI assigned

Sep 27, 2005

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Jill N Carter

Title

Ex Director

Phone

(707) 743-1188

Specialties & licenses 1

Addresses

Other identifiers 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1127779200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1083600894",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 238",
            "city": "POTTER VALLEY",
            "state": "CA",
            "postal_code": "954690238",
            "telephone_number": "707-743-1188",
            "fax_number": "707-743-1192"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10175 MAIN ST",
            "city": "POTTER VALLEY",
            "state": "CA",
            "postal_code": "954699749",
            "telephone_number": "707-743-1188",
            "fax_number": "707-743-1192"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "POTTER VALLEY COMMUNITY HEALTH CTR",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-09-27",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "CARTER",
        "authorized_official_first_name": "JILL",
        "authorized_official_middle_name": "N",
        "authorized_official_title_or_position": "EX DIRECTOR",
        "authorized_official_telephone_number": "707-743-1188"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "CA",
            "license": "FHC03879F",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "FHC03879F",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Melody Osburn
• Taylor Pallesen
• Kathleen Phillips
• Damian Pickron
• Britney Pimentel
• Potter Valley Youth and Community Center, Inc.
• James Pretorius, M.D.
• Redwood Community Services, Inc
• Redwood Community Services, Inc.
• Nathan Reitan

• Clinic/Center in Potter Valley, CA
• Providers in Potter Valley, CA by specialty
• Clinic/Center in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.