Healthcare Provider Details

I. General information

NPI: 1295752384
Provider Name (Legal Business Name): NORTHERN VALLEY INDIAN HEALTH INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2006
Last Update Date: 07/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

207 N BUTTE ST
WILLOWS CA
95988-2803
US

IV. Provider business mailing address

207 N BUTTE ST
WILLOWS CA
95988-2803
US

V. Phone/Fax

Practice location:
  • Phone: 530-934-9293
  • Fax: 530-934-2204
Mailing address:
  • Phone: 530-934-9293
  • Fax: 530-934-2204

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number230000212
License Number StateCA

VIII. Authorized Official

Name: MRS. LARISSA TAMBLE
Title or Position: FISCAL MANGAGEMENT DIRECTOR
Credential:
Phone: 530-934-9293