=====================================================
General NPI Number Information
=====================================================
NPI Number | 1487669032
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LAST FRONTIER HEALTHCARE DISTRICT
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/30/2006
-----------------------------------------------------
Last Update Date | 10/15/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1111 N NAGLE ST
-----------------------------------------------------
City | ALTURAS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 96101-3840
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 530-708-8800
-----------------------------------------------------
Fax | 530-233-6609
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 190
-----------------------------------------------------
City | ALTURAS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 96101-0190
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 530-708-8800
-----------------------------------------------------
Fax | 530-233-6609
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | MR. KEVIN KRAMER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 530-708-8801
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 275N00000X
-----------------------------------------------------
Taxonomy Name | Medicare Defined Swing Bed Hospital Unit
-----------------------------------------------------
License Number | 05Z330
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 282NR1301X
-----------------------------------------------------
Taxonomy Name | Rural Acute Care Hospital
-----------------------------------------------------
License Number | 230000026
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 282NC0060X
-----------------------------------------------------
Taxonomy Name | Critical Access Hospital
-----------------------------------------------------
License Number | 051330
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------