Healthcare Provider Details

I. General information

NPI: 1891762985
Provider Name (Legal Business Name): PIT RIVER HEALTH SERVICE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2006
Last Update Date: 01/25/2023
Certification Date: 01/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36977 PARK AVE
BURNEY CA
96013
US

IV. Provider business mailing address

36977 PARK AVE
BURNEY CA
96013-4067
US

V. Phone/Fax

Practice location:
  • Phone: 530-335-5090
  • Fax: 530-335-5241
Mailing address:
  • Phone: 530-335-5090
  • Fax: 530-335-5241

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number230000179
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number230000179
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code332800000X
TaxonomyIndian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: BRANDI GIBBS
Title or Position: BUSINESS SERVICES MANAGER
Credential:
Phone: 530-335-5090