1265567127 NPI number — NORTHERN VALLEY INDIAN HEALTH, INC

Table of content: (NPI 1265567127)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265567127 NPI number — NORTHERN VALLEY INDIAN HEALTH, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTHERN VALLEY INDIAN HEALTH, 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:
THERESA CAMERON
Provider Other Organization Name Type Code:
5
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:
1265567127
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/22/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
207 N BUTTE ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WILLOWS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95988-2803
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
530-934-9293
Provider Business Mailing Address Fax Number:
530-934-2204

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
845 W EAST AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHICO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95926-2002
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-896-9400
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/22/2007

Additional Information

Authorized Official

Authorized Official Last Name:
TAMBLE
Authorized Official First Name:
LARISSA
Authorized Official Middle Name:
Authorized Official Title or Position:
FISCAL MANGAGEMENT DIRECTOR
Authorized Official Telephone Number:
530-934-9293

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: THP70710F , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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