NPIMap

Organization Active NPI

Siskiyou Community Health Center Inc

  • Federally Qualified Health Center (FQHC)
  • Grants Pass, OR
National Provider Identifier
1205002136
Registry record updated Jun 30, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
SISKIYOU COMMUNITY HEALTH CENTER INC
Practice address
1701 NW Hawthorne Ave
Grants Pass, OR 97526-1051
Phone
(541) 479-6393
Fax
(541) 479-6489
NPI assigned
Apr 30, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 30, 2026

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

Authorized official

Name
Eric Van Houten, MSW, MBA
Title
Ceo
Phone
(541) 472-4777

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223G0001X
Dental HygienistGroup: 193400000X SINGLE SPECIALTY GROUP 124Q00000X H3448 OR
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

1701 NW Hawthorne Ave
Grants Pass, OR 97526-1051

Mailing address

1701 NW Hawthorne Ave
Grants Pass, OR 97526-1051
Phone (541) 479-6393

Other identifiers 1

IdentifierTypeStateIssuer
127725MedicaidOR

Other names 1

  • Siskiyou Community Health Center Dental Facility Other name

National Provider Directory

National Provider Directory
Tax ID family
Siskiyou Community HLTH13 organizations share this tax ID, including this one

Other organizations with this tax ID 12

Organizations that report the same tax identification number in the National Provider Directory.

Locations

1701 NW Hawthorne Ave
Grants Pass, OR 97526
Phone (541) 471-3455

1035 NE 6th St
Ste B
Grants Pass, OR 97526
Phone (541) 479-6393

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1209513600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1782777600000",
    "number": "1205002136",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1701 NW HAWTHORNE AVE",
            "city": "GRANTS PASS",
            "state": "OR",
            "postal_code": "975261051",
            "telephone_number": "541-479-6393",
            "fax_number": "541-472-4701"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1701 NW HAWTHORNE AVE",
            "city": "GRANTS PASS",
            "state": "OR",
            "postal_code": "975261051",
            "telephone_number": "541-479-6393",
            "fax_number": "541-479-6489"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SISKIYOU COMMUNITY HEALTH CENTER INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-04-30",
        "last_updated": "2026-06-30",
        "certification_date": "2026-06-30",
        "status": "A",
        "authorized_official_last_name": "VAN HOUTEN",
        "authorized_official_first_name": "ERIC",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "541-472-4777",
        "authorized_official_credential": "MSW, MBA"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "124Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dental Hygienist",
            "state": "OR",
            "license": "H3448",
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "127725",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Siskiyou Community Health Center Dental Facility",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Siskiyou Community Health Center Dental Facility",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Grants Pass, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 30, 2026; 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.