Healthcare Provider Details

I. General information

NPI: 1326217829
Provider Name (Legal Business Name): HUPA HEALTH ASSOCIATION, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2008
Last Update Date: 06/10/2022
Certification Date: 06/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

535 AIRPORT RD STE 104
HOOPA CA
95546-9615
US

IV. Provider business mailing address

535 AIRPORT RD STE 104
HOOPA CA
95546-9615
US

V. Phone/Fax

Practice location:
  • Phone: 530-625-4585
  • Fax: 530-625-4312
Mailing address:
  • Phone: 530-625-4585
  • Fax: 530-625-4312

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License NumberEXEMPT INDIAN TRIBE
License Number StateCA

VIII. Authorized Official

Name: DR. STEPHEN STAKE
Title or Position: INTERIM CEO
Credential: DRPH, MHS, CPH
Phone: 530-625-4261