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General NPI Number Information
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NPI Number | 1952120354
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Entity Type | Organization
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Legal Business Name | BLUE LAKE RANCHERIA
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Dates
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Enumeration Date | 10/03/2024
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Last Update Date | 10/03/2024
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Provider Practice Location Address
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Address Line | 428 CHARTIN RD
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City | BLUE LAKE
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State | CA
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Zip | 95525-9722
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Country | US
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Telephone | 707-668-5101
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Fax | 707-668-7226
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Provider Business Mailing Address
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Address Line | PO BOX 428
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City | BLUE LAKE
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State | CA
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Zip | 95525-0428
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Country | US
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Telephone | 707-668-7226
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Fax |
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Authorized Official
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Title or Position | TRIBAL ADMINSTRATOR
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Name | DR. JASON RAMOS
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Credential | DC
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Telephone | 707-668-7226
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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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 | 251K00000X
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Taxonomy Name | Public Health or Welfare Agency
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QF0050X
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Taxonomy Name | Non-Surgical Family Planning Clinic/Center
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 261QC1500X
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Taxonomy Name | Community Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 332U00000X
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Taxonomy Name | Home Delivered Meals
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 385H00000X
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Taxonomy Name | Respite Care
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License Number |
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License Number State |
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Taxonomy #8
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Taxonomy Code | 174200000X
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Taxonomy Name | Meals Provider
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License Number |
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License Number State |
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Taxonomy #9
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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