=====================================================
General NPI Number Information
=====================================================
NPI Number | 1952483406
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KARUK TRIBE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/20/2006
-----------------------------------------------------
Last Update Date | 01/30/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 64105 HILLSIDE ROAD
-----------------------------------------------------
City | HAPPY CAMP
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 96039
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 530-493-1450
-----------------------------------------------------
Fax | 530-493-1451
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 1016
-----------------------------------------------------
City | HAPPY CAMP
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 96039-1016
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 530-493-5257
-----------------------------------------------------
Fax | 530-493-5270
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | BUSINESS OFFICE DIRECTOR
-----------------------------------------------------
Name | EILEEN MARY TIRATERRA
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 530-493-1600
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 208D00000X
-----------------------------------------------------
Taxonomy Name | General Practice Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------