1841622180 NPI number — NATIVE AMERICAN HEALTH CENTER INC

Table of content: (NPI 1841622180)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841622180 NPI number — NATIVE AMERICAN HEALTH CENTER INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NATIVE AMERICAN HEALTH CENTER 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:
6
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:
1841622180
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/04/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3124 INTERNATIONAL BLVD
Provider Second Line Business Mailing Address:
ROOM 314
Provider Business Mailing Address City Name:
OAKLAND
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94601-2902
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
510-434-5379
Provider Business Mailing Address Fax Number:
510-261-1841

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
160 CAPP ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN FRANCISCO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94110-1210
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
415-417-3597
Provider Business Practice Location Address Fax Number:
415-503-1081
Provider Enumeration Date:
08/08/2013

Additional Information

Authorized Official

Authorized Official Last Name:
ANTOINE
Authorized Official First Name:
LORI
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR REGISTRATION AND BILLING
Authorized Official Telephone Number:
510-485-5942

Provider Taxonomy Codes

  • Taxonomy code: 261QF0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: GR#2061SM#059036 . This is a "URBAN TRAILS SAN FRANCISCO" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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