Provider Demographics
NPI:1811329899
Name:AMPLA HEALTH
Entity type:Organization
Organization Name:AMPLA HEALTH
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:H
Authorized Official - Last Name:FLORES
Authorized Official - Suffix:
Authorized Official - Credentials:MPH
Authorized Official - Phone:530-751-3778
Mailing Address - Street 1:PO BOX AD
Mailing Address - Street 2:
Mailing Address - City:YUBA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95992-1396
Mailing Address - Country:US
Mailing Address - Phone:530-751-3778
Mailing Address - Fax:530-751-1237
Practice Address - Street 1:7981 HIGHWAY 99E
Practice Address - Street 2:
Practice Address - City:LOS MOLINOS
Practice Address - State:CA
Practice Address - Zip Code:96055-9782
Practice Address - Country:US
Practice Address - Phone:530-384-4010
Practice Address - Fax:530-384-4016
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-01
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
CA261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
No171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1811329899Medicaid
CA1811329899Medicaid
CA751122Medicare Oscar/Certification