Samantha Bacon
Individual provider Active NPI Community Health Worker · Willits, CA
NPI 1235014333 · NPPES record last updated Aug 7, 2025
Key facts
- NPI
- 1235014333
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Community Health Worker 172V00000X
- Practice address
- 258 State St
Willits, CA 95490-3120 - Phone
- (707) 354-0846
- Fax
- (707) 354-0846
- NPI assigned
- Aug 7, 2025
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community Health Worker | 172V00000X | Yes |
Addresses
Primary practice location
258 State St
Willits, CA 95490-3120
Mailing address
455 Cypress Ave
Ukiah, CA 95482-3921
Phone (707) 354-0846
Other providers in Willits, CA
- Bruce Robert Andich
- Sabrina Angell
- Margaret Lucy Arner
- James Avalos
- Hossein Azadi
- Ace Barash
- Maria Theresa Bates
- Anastasia Beloshapko
- Cinder Benitez
- Judith Ann Berdis
All providers in Willits, CA · Community Health Worker in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 7, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.