Provider Demographics
NPI:1992736086
Name:WINTERS HEALTHCARE FOUNDATION, INC.
Entity type:Organization
Organization Name:WINTERS HEALTHCARE FOUNDATION, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:KELSCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:530-795-4377
Mailing Address - Street 1:172 E GRANT AVE
Mailing Address - Street 2:
Mailing Address - City:WINTERS
Mailing Address - State:CA
Mailing Address - Zip Code:95694-1780
Mailing Address - Country:US
Mailing Address - Phone:530-795-4377
Mailing Address - Fax:530-795-9541
Practice Address - Street 1:172 E GRANT AVE
Practice Address - Street 2:
Practice Address - City:WINTERS
Practice Address - State:CA
Practice Address - Zip Code:95694-1780
Practice Address - Country:US
Practice Address - Phone:530-795-4377
Practice Address - Fax:530-795-9541
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-06
Last Update Date:2020-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA030000787OtherSTATE LICENSE
CAHAP71037FMedicaid
CAZZZ04589ZOtherMEDICARE PTAN
CA2254671OtherSTATE CORPORATION NUMBER
CABCP71037FMedicaid
CAFHC71037FMedicaid
CA2254671OtherSTATE CORPORATION NUMBER