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General NPI Number Information
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NPI Number | 1891762985
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Entity Type | Organization
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Legal Business Name | PIT RIVER HEALTH SERVICE, INC.
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Dates
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Enumeration Date | 03/07/2006
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Last Update Date | 01/25/2023
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Provider Practice Location Address
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Address Line | 36977 PARK AVE
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City | BURNEY
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State | CA
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Zip | 96013
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Country | US
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Telephone | 530-335-5090
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Fax | 530-335-5241
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Provider Business Mailing Address
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Address Line | 36977 PARK AVE
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City | BURNEY
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State | CA
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Zip | 96013-4067
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Country | US
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Telephone | 530-335-5090
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Fax | 530-335-5241
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Authorized Official
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Title or Position | BUSINESS SERVICES MANAGER
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Name | BRANDI GIBBS
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Credential |
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Telephone | 530-335-5090
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332800000X
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Taxonomy Name | Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QC1500X
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Taxonomy Name | Community Health Clinic/Center
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License Number | 230000179
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 261QR1300X
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Taxonomy Name | Rural Health Clinic/Center
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License Number | 230000179
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License Number State | CA
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