PF
Medical Clinic
PROVIDENCE FAMILY PRACTICE
3302 RENNER DRIVE, SUITE A, FORTUNA, CA 95540
Source updated 2026-10-16. Source-listed location, not a NursingHomes.io endorsement. Confirm operating status, care availability, and services directly.
Official provider information
- CCN
- 058698
- LTC
- NON-LTC
- NPI
- 1194189654
- ZIP
- 95540
- id
- 2231
- CITY
- FORTUNA
- FLAG
- Not reported
- ZIP9
- 7103
- rank
- 0.057308756
- AO CD
- Not reported
- FACID
- 110000676
- DEEMED
- 0
- T18 19
- Not reported
- ADDRESS
- 3302 RENNER DRIVE, SUITE A
- AO NAME
- Not reported
- FACNAME
- PROVIDENCE FAMILY PRACTICE
- FAC FDR
- PRIMARY CARE CLINIC
- HCAI ID
- Not reported
- CAPACITY
- 0
- LATITUDE
- 40.58238845
- LOCATION
- (-124.1360238,40.582388451)
- DATA DATE
- 2026-10-16T00:00:00
- ISFACMAIN
- N
- LONGITUDE
- -124.1360238
- CCLHO CODE
- 12
- CCLHO NAME
- HUMBOLDT
- START DATE
- 19JUN2017
- TRAUMA CTR
- Not reported
- ASPEN FACID
- CA11000000676
- COUNTY CODE
- 110
- COUNTY NAME
- HUMBOLDT
- TERMINAT SW
- Not reported
- AO TRMNTN DT
- Not reported
- DMG EFCTV DT
- Not reported
- PARENT FACID
- 110000045
- TYPE OF CARE
- Not reported
- APPROVAL DATE
- 2017-08-28T00:00:00
- BUSINESS NAME
- ST. JOSEPH HEALTH NORTHERN CALIFORNIA LLC
- DISTRICT NAME
- SANTA ROSA
- FAC TYPE CODE
- RHC
- LICENSE NUMBER
- 110000173
- TRAUMA PED CTR
- Not reported
- DISTRICT NUMBER
- 11
- FIPS COUNTY CODE
- 6023
- LICENSED CERTIFIED
- LICENSED AND CERTIFIED
- PARTICIPATION DATE
- 2016-12-07T00:00:00
- CONTACT PHONE NUMBER
- (707) 725-3318
- FAC STATUS TYPE CODE
- OPEN
- INITIAL LICENSE DATE
- 1957-03-19T00:00:00
- BIRTHING FACILITY FLAG
- Not reported
- CAN BE DEEMED FAC TYPE
- Y
- LICENSE EFFECTIVE DATE
- 2025-11-01T00:00:00
- ENTITY TYPE DESCRIPTION
- LIMITED LIABILITY COMPANY
- LICENSE EXPIRATION DATE
- 2026-10-31T00:00:00
- CRITICAl ACCESS HOSPITAL
- Not reported
- CAN BE CERTIFIED FAC TYPE
- Y
- LICENSE STATUS DESCRIPTION
- ACTIVE
- FAC FAC RELATIONSHIP TYPE CODE
- OTHER CERTIFIABLE PART
COMMUNITY EXPERIENCE
Reviews of PROVIDENCE FAMILY PRACTICE
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