SANTA ROSA COMMUNITY HEALTH CENTERS (NPI# 1780195255) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1780195255 |
Entity Type | Organization |
Organization Name | SANTA ROSA COMMUNITY HEALTH CENTERS |
Other Organization Name | DUTTON CAMPUS |
Practice Address |
1300 N Dutton Ave Santa Rosa CA 95401-7112 |
Mailing Address |
3569 Round Barn Cir Santa Rosa CA 95403-5781 |
Practice Telephone | 7073033600 |
Mailing Telephone | 7073033600 |
Enumeration Date | 2017-10-23 |
Last Update Date | 2018-06-16 |
Authorized Official Name | HAROLD BROCKMAN (CFO) |
Authorized Official Telephone | 7073033600 |
Is Organization Subpart | Y |
Parent Organization Name | SANTA ROSA COMMUNITY HEALTH CENTERS |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
Y | 261QF0400X |
Clinic/Center Specialization: Federally Qualified Health Center (FQHC) |
Ambulatory Health Care Facilities |
Other Name | Type Code |
---|---|
Dutton Campus | Other Name - Individual/Organization |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1962613349 | Santa Rosa Community Health Centers | Clinic/Center | 3569 Round Barn Circle, Santa Rosa, CA 95403-5781 | 2007-05-25 |
1871651273 | Santa Rosa Community Health Centers | Clinic/Center | 599 Bellevue Ave, Santa Rosa, CA 95407-7713 | 2006-12-05 |
1689742215 | Santa Rosa Community Health Centers | Clinic/Center | 684 Benecia Drive, Santa Rosa, CA 95409-3058 | 2006-12-01 |
1518345511 | Santa Rosa Community Health Centers | Clinic/Center | 3333 Chanate Rd, Santa Rosa, CA 95404-1707 | 2015-05-11 |
1255600037 | Santa Rosa Community Health Centers | Community/Behavioral Health | 3569 Round Barn Cir, Santa Rosa, CA 95403-5781 | 2011-12-22 |
1184909103 | Santa Rosa Community Health Centers | Clinic/Center | 983 Sonoma Ave, Santa Rosa, CA 95404-4818 | 2011-10-21 |
1558512624 | Santa Rosa Community Health Centers | Clinic/Center | 711 Stony Point Rd Ste 17, Santa Rosa, CA 95407-6848 | 2008-10-07 |
1114120623 | Santa Rosa Community Health Centers | Clinic/Center | 751 Lombardi Court, Santa Rosa, CA 95407-6793 | 2007-06-11 |
1578766085 | Santa Rosa Community Health Centers | Clinic/Center | 751 Lombardi Ct Ste B, Santa Rosa, CA 95407-6793 | 2007-06-11 |
1487857991 | Santa Rosa Community Health Centers | Clinic/Center | 751 Lombardi Court, Santa Rosa, CA 95407-6793 | 2007-06-11 |
Entity Type | Entity Name | Entity Address |
---|---|---|
System for Award Management (SAM) Entities | SANTA ROSA COMMUNITY HEALTH CENTERS | 3569 Round Barn Cir, Santa Rosa, CA 95403-5781 |
Street Address |
1300 N DUTTON AVE |
City | SANTA ROSA |
State | CA |
Zip Code | 95401-7112 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1487649711 | Patricia Whooley Kulawiak | Family Medicine | 1300 N Dutton Ave, Santa Rosa, CA 95401 | 2005-09-13 |
1245830223 | Alexy Francisco Andrade | Nurse Practitioner | 1300 N Dutton Ave, Santa Rosa, CA 95401-7112 | 2020-10-28 |
1558997569 | Nicole Fernandes | Nurse Practitioner | 1300 N Dutton Ave, Santa Rosa, CA 95401-7112 | 2020-03-21 |
1588207351 | Megan Culligan | Nurse Practitioner | 1300 N Dutton Ave, Santa Rosa, CA 95401-7112 | 2019-10-23 |
1376185272 | Ryan Duval | Acupuncturist | 1300 N Dutton Ave, Santa Rosa, CA 95401-7112 | 2019-10-11 |
1386295160 | Jordan Michele Petersen | Dental Hygienist | 1300 N Dutton Ave, Santa Rosa, CA 95401-7112 | 2019-09-24 |
1871153734 | Priscilla Lujan Rodriguez | Nurse Practitioner | 1300 N Dutton Ave, Santa Rosa, CA 95401-7112 | 2019-06-13 |
1770148108 | Jennifer Nicole Francis | Nurse Practitioner | 1300 N Dutton Ave, Santa Rosa, CA 95401-7112 | 2019-05-01 |
1770059750 | Brittany English | Nurse Practitioner | 1300 N Dutton Ave, Santa Rosa, CA 95401-7112 | 2018-10-17 |
1386129294 | Claire Maureen Kugler | Nurse Practitioner | 1300 N Dutton Ave, Santa Rosa, CA 95401-7112 | 2018-09-26 |
Find all providers in the same location |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1972148575 | Megan Elizabeth Jones | In Home Supportive Care | 1239 Eardley Ave, Santa Rosa, CA 95401 | 2019-11-07 |
1801447230 | Patty Macisaac | Technician | 3221 Oak Farm Lane, Santa Rosa, CA 95401 | 2019-09-26 |
1386114981 | Victoria Maria Guillory | Dental Hygienist | 140 Stony Point Road, Suite A, Santa Rosa, CA 95401 | 2018-11-27 |
1811470727 | Chemarin Eve Boyd | Student in an Organized Health Care Education/Training Program | 1260 N Dutton Avenue, 225, Santa Rosa, CA 95401 | 2018-09-07 |
1073008181 | Cristavel Camacho | Behavioral Analyst | 1439 Range Ave, #101, Santa Rosa, CA 95401 | 2018-06-30 |
1619479102 | Victoria King | Behavior Technician | 1335 N. Dutton Ave., Santa Rosa, CA 95401 | 2018-03-01 |
1114436060 | Lacey Lynn Palmer | Counselor | 341 Irwin Lane, Santa Rosa, CA 95401 | 2017-09-22 |
1720530587 | Compassionate Homecare Solutions, LLC | In Home Supportive Care | 131 A Stony Circle, Suite 500, Santa Rosa, CA 95401 | 2016-10-27 |
1366998981 | William Glenn | Marriage & Family Therapist | 1496 Willowside Road, Santa Rosa, CA 95401 | 2016-09-01 |
1790144046 | Advocacy Home Nursing, Inc | Home Health | 1400 North Dutton Avenue, Suite 20, Santa Rosa, CA 95401 | 2016-02-15 |
Find all providers in zip 95401 |
Taxonomy Code | 261QF0400X |
Grouping | Ambulatory Health Care Facilities |
Classification | Clinic/Center |
Specialization | Federally Qualified Health Center (FQHC) |
Definition to come... |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1386960862 | Su Clinica Familiar | Clinic/Center | Hwy 107 and La Feria Avenue, Santa Rosa, TX 78593-0226 | 2010-04-09 |
1871651273 | Santa Rosa Community Health Centers | Clinic/Center | 599 Bellevue Ave, Santa Rosa, CA 95407-7713 | 2006-12-05 |
1245739697 | Santa Rosa Community Health Center | Clinic/Center | 3883 Airway Dr Ste 202, Santa Rosa, CA 95403-1671 | 2018-02-12 |
1518345511 | Santa Rosa Community Health Centers | Clinic/Center | 3333 Chanate Rd, Santa Rosa, CA 95404-1707 | 2015-05-11 |
1184909103 | Santa Rosa Community Health Centers | Clinic/Center | 983 Sonoma Ave, Santa Rosa, CA 95404-4818 | 2011-10-21 |
1558512624 | Santa Rosa Community Health Centers | Clinic/Center | 711 Stony Point Rd Ste 17, Santa Rosa, CA 95407-6848 | 2008-10-07 |
1114120623 | Santa Rosa Community Health Centers | Clinic/Center | 751 Lombardi Court, Santa Rosa, CA 95407-6793 | 2007-06-11 |
1578766085 | Santa Rosa Community Health Centers | Clinic/Center | 751 Lombardi Ct Ste B, Santa Rosa, CA 95407-6793 | 2007-06-11 |
1487857991 | Santa Rosa Community Health Centers | Clinic/Center | 751 Lombardi Court, Santa Rosa, CA 95407-6793 | 2007-06-11 |
1568665073 | Santa Rosa Community Health Centers | Clinic/Center | 599 Bellevue Ave, Santa Rosa, CA 95407-7713 | 2007-06-11 |
Find all providers in SANTA ROSA |
City | SANTA ROSA |
Zip Code | 95401 |
Please comment or provide details below to improve the information on SANTA ROSA COMMUNITY HEALTH CENTERS.
Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.