1215955935 NPI number — CONSOLIDATED TRIBAL HEALTH PROJECT INC

Table of content: (NPI 1215955935)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215955935 NPI number — CONSOLIDATED TRIBAL HEALTH PROJECT INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CONSOLIDATED TRIBAL HEALTH PROJECT INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1215955935
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 387
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CALPELLA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95418-0387
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
707-485-5115
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6991 N STATE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
REDWOOD VALLEY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95470-9629
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
707-485-5115
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/18/2006

Additional Information

Authorized Official

Authorized Official Last Name:
GONZALEZ
Authorized Official First Name:
MARY ANN
Authorized Official Middle Name:
NMN
Authorized Official Title or Position:
CLINI DIRECTORC
Authorized Official Telephone Number:
707-485-5115

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  31614 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2024 www.npivalidator.com