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General NPI Number Information
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NPI Number | 1013882877
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Entity Type | Organization
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Legal Business Name | GREENVILLE RANCHERIA
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Dates
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Enumeration Date | 10/09/2025
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Last Update Date | 10/09/2025
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Provider Practice Location Address
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Address Line | 2638 EDITH AVE
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City | REDDING
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State | CA
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Zip | 96001-3043
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Country | US
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Telephone | 530-244-7192
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Fax | 530-244-4185
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Provider Business Mailing Address
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Address Line | 2638 EDITH AVE
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City | REDDING
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State | CA
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Zip | 96001-3043
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Country | US
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Telephone | 530-244-7192
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Fax | 530-244-4185
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Authorized Official
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Title or Position | BILLING SUPERVISOR
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Name | ANTONIA LOUISE HAYWORTH
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Credential | CPC
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Telephone | 530-528-8600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number |
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License Number State |
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