| Organization Name: | COMMUNITY HEALTH CLINIC OLE |
| NPI Number: | 1760660831 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | TANIR AMI (CEO) |
| Mailing Address: | 911 Washington St Calistoga |
| State: | CA US |
| Postal Code: | 945151433 |
| Phone Number: | 7077092308 |
| Fax Number: | |
| NPI Enumeration Date: | 01/31/2008 |
| NPI Last Update Date: | 04/03/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QF0400X |
| License Number: | 550000616 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Federally Qualified Health Center (FQHC) |
| Taxonomy Definition: | |