Provider Demographics
NPI:1326031881
Name:GREENVILLE RANCHERIA
Entity Type:Organization
Organization Name:GREENVILLE RANCHERIA
Other - Org Name:GREENVILLE RANCHERIA TRIBAL HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:FISCAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:PATTY
Authorized Official - Middle Name:
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:530-284-7990
Mailing Address - Street 1:PO BOX 279
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95947-0279
Mailing Address - Country:US
Mailing Address - Phone:530-284-7990
Mailing Address - Fax:530-284-7299
Practice Address - Street 1:410 MAIN STREET
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:CA
Practice Address - Zip Code:95947-0279
Practice Address - Country:US
Practice Address - Phone:530-284-6135
Practice Address - Fax:530-284-7594
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-30
Last Update Date:2009-03-12
Deactivation Date:2007-07-17
Deactivation Code:
Reactivation Date:2007-08-21
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CATHP70390GMedicaid
CA051930Medicare Oscar/Certification