Healthcare Provider Details

I. General information

NPI: 1033246798
Provider Name (Legal Business Name): KLAMATH TRINITY NON-EMERGENCY TRANSPORTATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

38883 HIGHWAY 299
WILLOW CREEK CA
95573-1147
US

IV. Provider business mailing address

PO BOX 1147
WILLOW CREEK CA
95573-1147
US

V. Phone/Fax

Practice location:
  • Phone: 530-629-1192
  • Fax: 530-629-1193
Mailing address:
  • Phone: 530-629-1192
  • Fax: 530-629-1193

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number7U55682
License Number StateCA

VIII. Authorized Official

Name: MRS. TERRI L. CASTNER
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 530-629-1192