Provider Demographics
NPI:1184221061
Name:YUROK TRIBE
Entity Type:Organization
Organization Name:YUROK TRIBE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TRANSIT MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:MIGUELENA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:707-482-1350
Mailing Address - Street 1:PO BOX 1027
Mailing Address - Street 2:
Mailing Address - City:KLAMATH
Mailing Address - State:CA
Mailing Address - Zip Code:95548-1027
Mailing Address - Country:US
Mailing Address - Phone:707-482-1350
Mailing Address - Fax:
Practice Address - Street 1:190 KLAMATH BLVD
Practice Address - Street 2:
Practice Address - City:KLAMATH
Practice Address - State:CA
Practice Address - Zip Code:95548-1027
Practice Address - Country:US
Practice Address - Phone:707-482-1350
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:YUROK TRIBE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-10-05
Last Update Date:2021-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)