| Organization Name: | COLUSA INDIAN COMMUNITY COUNCIL |
| NPI Number: | 1548302433 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | MARK SPRAGUE (CLINIC DIRECTOR) |
| Mailing Address: | 3710 Highway 45 Colusa |
| State: | CA US |
| Postal Code: | 959324021 |
| Phone Number: | 5304585501 |
| Fax Number: | 5304588660 |
| NPI Enumeration Date: | 02/14/2007 |
| NPI Last Update Date: | 02/06/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QE0700X |
| License Number: | CDC52534F |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | End-Stage Renal Disease (ESRD) Treatment |
| Taxonomy Definition: | |