Siskiyou Community Health Center, Inc.
Organization Active NPI Federally Qualified Health Center (FQHC) · Cave Junction, OR
NPI 1669638417 · NPPES record last updated Jun 30, 2026
Key facts
- NPI
- 1669638417
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Federally Qualified Health Center (FQHC) 261QF0400X
- License
- 127725 (OR)
- Legal business name
- SISKIYOU COMMUNITY HEALTH CENTER, INC.
- Practice address
- 25647 Redwood Hwy
Cave Junction, OR 97523-9332 - Phone
- (541) 592-4111
- Fax
- (541) 592-3916
- NPI assigned
- Jul 31, 2008
- Organization subpart
- Yes
- Parent organization (as reported)
- SISKIYOU COMMUNITY HEALTH CENTER INC
Authorized official
- Name
- Eric Van Houten, MSW, MBA
- Title
- Ceo
- Phone
- (541) 472-4777
Other NPIs on the same Medicare enrollment 1
Other NPIs with the same Medicare PAC ID 1
Practitioners 34
-
Mary Lou Alonso, NP1578815783
-
Laura Anderson, DNP APRN-NP
-
Glendon E Cook, M.D.
-
Tiffany M Crane, NP
-
Meg Irene Dotson, MD
-
M Crystal Hill, M.D.
-
Mona Kaahu, PMHNP
-
Jill Denise Lary, RN, FNP-C
-
Elizabeth Anne Mabry, CSWI
-
Andrew Martin, FNP-BC
-
Daniel McDonnell, MSN PMH-NP
-
Kristin Miller, M.D.
-
Kimberly Kristi Smith, APRN-NP
-
Nichole Steward, MSN, FNP-C
-
Amy Leigh Wills, FNP
-
Robin H Celkupa, PHD, MSSW
-
Andre Luiz Bezerra, FNP
-
Amber Ihander, PA-C
-
Samantha Marzorati, PA-C
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in OR
Federally qualified health center certification: CCN 381865
- Legal name
- SISKIYOU COMMUNITY HEALTH CENTER INC
- Certification status
- Active
- Provider type (POS)
- Federally qualified health center
- Participating since
- May 3, 2004
- Last certification
- May 3, 2004
- Ownership / control type
- For profit – partnership
- Organization structure
- Corporation · Non-profit
- Incorporated
- May 1, 1975 in OR
- Enrollment address
- 25647 Redwood Hwy
Cave Junction, OR 97523-9332
All disclosed owners & managing parties 14
| Name | Role | Since | Share |
|---|---|---|---|
| Janet M Capetty |
Corporate Officer |
Feb 1, 2024 | |
| Bruce McKee |
Corporate Officer |
Dec 19, 2023 | |
| Joya H Feltzin |
Corporate Officer |
Feb 12, 2025 | |
| Lyle T Jackson |
Corporate Officer |
Sep 6, 2021 | |
| Monica E McFadden |
Corporate Officer |
Oct 28, 2021 | |
| Brad W Lamont |
Corporate Officer |
Jun 20, 2019 | |
| Robin Hausen |
Corporate Officer |
Jan 8, 2021 | |
| William Ward |
Corporate Officer |
Jun 13, 2022 | |
| James R Vanhorne |
Corporate Officer |
Feb 15, 2025 | |
| Yolanda Valencia |
Corporate Officer |
Jun 26, 2023 | |
| Kris Sherman |
Corporate Officer | Jul 31, 2023 | |
| Gary Dunham |
Corporate Officer |
Oct 14, 2020 | |
| Eric T Van-Houten |
Corporate Director |
Jun 2, 2025 | |
| W-2 Managing Employee |
Jun 2, 2025 | ||
| Dawn L Weber |
Contracted Managing Employee |
Feb 22, 2024 | |
| Corporate Director |
Feb 22, 2024 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040114000536 | OR | Part B Supplier - Clinic/Group Practice | 6305747288 |
Receives reassigned benefits from 34 practitioners 1 other NPI on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Cave Junction, OR; Grants Pass, OR |
| O20080916000486 | OR | Part a Provider - Federally Qualified Health Center (FQHC) | 6305747288 | Practice locations: Cave Junction, OR |
National Provider Directory
- Part of
- Siskiyou Community HLTH
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Federally Qualified Health Center (FQHC) | 261QF0400X | 127725 | OR | Yes |
Addresses
Primary practice location
25647 Redwood Hwy
Cave Junction, OR 97523-9332
Mailing address
1701 NW Hawthorne Ave
Grants Pass, OR 97526-1051
Phone (541) 472-4777
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 127725 | Medicaid | OR |
Other providers in Cave Junction, OR
- Anita Gabriele Semper
- Siskiyou Community Health Center Inc
- Siskiyou Community Health Center Pharmacy
- Siskiyou Community Health Center Pharmacy
- Siskiyou Community Health Center, Inc.
- Siskiyou Community Health Center, Inc.
- Siskiyou Community Health Center, Inc.
- Jeffrey Allan Staab
- Mona Gitte Ritter Staehr
- William Douglas Steinman
All providers in Cave Junction, OR · Federally Qualified Health Center (FQHC) in Oregon
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 30, 2026. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.