=====================================================
General NPI Number Information
=====================================================
NPI Number | 1508765835
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PIT RIVER HEALTH SERVICE, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/03/2026
-----------------------------------------------------
Last Update Date | 11/03/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 36977 PARK AVE
-----------------------------------------------------
City | BURNEY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 96013-4067
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 530-335-5090
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 36977 PARK AVE
-----------------------------------------------------
City | BURNEY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 96013-4067
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | HUMAN RESOURCE MANAGER
-----------------------------------------------------
Name | SOPHIA RAE VILLARRUEL
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 530-335-0332
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332800000X
-----------------------------------------------------
Taxonomy Name | Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------