Provider Demographics
NPI:1003826009
Name:CONSOLIDATED TRIBAL HEALTH PROJECT, INC.
Entity Type:Organization
Organization Name:CONSOLIDATED TRIBAL HEALTH PROJECT, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:GUZMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:707-467-5616
Mailing Address - Street 1:PO BOX 387
Mailing Address - Street 2:
Mailing Address - City:CALPELLA
Mailing Address - State:CA
Mailing Address - Zip Code:95418-0387
Mailing Address - Country:US
Mailing Address - Phone:707-485-5115
Mailing Address - Fax:707-485-7792
Practice Address - Street 1:6991 N STATE ST
Practice Address - Street 2:
Practice Address - City:REDWOOD VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95470-9629
Practice Address - Country:US
Practice Address - Phone:707-485-5115
Practice Address - Fax:707-467-5698
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-09
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA110000210261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAEAP70442FOtherEAPC
CATHP70442FMedicaid
CAHAP70442FOtherFAMILY PACT
CAZZZ26930ZMedicare ID - Type UnspecifiedMEDICARE ID