Southern Trinity Health Inc
Organization Active NPI Federally Qualified Health Center (FQHC) · Mad River, CA
NPI 1316121007 · NPPES record last updated Apr 21, 2022
Key facts
- NPI
- 1316121007
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Federally Qualified Health Center (FQHC) 261QF0400X
- Legal business name
- SOUTHERN TRINITY HEALTH INC
- Practice address
- 153-A Van Duzen Rd
Mad River, CA 95552 - Phone
- (707) 574-6616
- Fax
- (707) 574-6523
- NPI assigned
- Dec 18, 2007
- Organization subpart
- No
Authorized official
- Name
- Graylan Lupton
- Title
- Chief Executive Officer
- Phone
- (707) 574-6616
Corporate family (same tax ID) 5
National Provider Directory
- Tax ID family
- Southern Trinity Health Inc
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Federally Qualified Health Center (FQHC) | 261QF0400X | Yes |
Addresses
Primary practice location
153-A Van Duzen Rd
Mad River, CA 95552
Mailing address
PO Box 7
Scotia, CA 95565-0007
Phone (707) 764-5617
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| EAP70040F | Medicaid | CA |
Other providers in Mad River, CA
- Georgene Bernice Chase
- Nicholas Neal Entsminger
- Patricia Diane Farmer
- Southern Trinity Area Rescue Inc
- Southern Trinity Health Inc
- The Wecare Group, Inc.
- The Wecare Group, Inc.
- James William Tinkelenberg
All providers in Mad River, CA · Federally Qualified Health Center (FQHC) in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 21, 2022. 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.