| Petaluma Health Center Inc | |
|
88 Mesa Rd Bolinas CA 94924-9713 | |
| (415) 868-0124 | |
| (415) 868-2152 |
| Full Name | Petaluma Health Center Inc |
|---|---|
| Speciality | Clinic/Center |
| Location | 88 Mesa Rd, Bolinas, California |
| Authorized Official Name and Position | Molly Jouaneh (CFO) |
| Authorized Official Contact | 7075597500 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Petaluma Health Center Inc 1455 N Mcdowell Blvd Ste D Petaluma CA 94954-6503 Ph: (707) 559-7500 | Petaluma Health Center Inc 88 Mesa Rd Bolinas CA 94924-9713 Ph: (415) 868-0124 |
| NPI Number | 1760584049 |
|---|---|
| Provider Enumeration Date | 09/05/2006 |
| Last Update Date | 06/08/2021 |
| Medicare PECOS PAC ID | 9133180375 |
|---|---|
| Medicare Enrollment ID | O20200921001805 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1760584049 | NPI | - | NPPES |
| FHC03885G | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | 110000397 (California) | Primary |
Coastal Health Alliance Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 451 Mesa Road, Bolinas, CA 94924 Phone: 415-663-8666 Fax: 415-663-9532 |