Provider Demographics
NPI:1053880245
Name:COLUSA INDIAN COMMUNITY COUNCIL
Entity type:Organization
Organization Name:COLUSA INDIAN COMMUNITY COUNCIL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF CLINIC OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:CATRINA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:ROSS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:530-458-6542
Mailing Address - Street 1:3710 HIGHWAY 45
Mailing Address - Street 2:
Mailing Address - City:COLUSA
Mailing Address - State:CA
Mailing Address - Zip Code:95932-4026
Mailing Address - Country:US
Mailing Address - Phone:530-458-6542
Mailing Address - Fax:530-458-8660
Practice Address - Street 1:360 5TH ST
Practice Address - Street 2:
Practice Address - City:COLUSA
Practice Address - State:CA
Practice Address - Zip Code:95932-2467
Practice Address - Country:US
Practice Address - Phone:530-458-3614
Practice Address - Fax:530-458-4047
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COLUSA INDIAN COMMUNITY COUNCIL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-11-16
Last Update Date:2018-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental