Provider Demographics
NPI:1689863516
Name:NATIVE AMERICAN HEALTH CENTER INC
Entity Type:Organization
Organization Name:NATIVE AMERICAN HEALTH CENTER INC
Other - Org Name:URBAN INDIAN HEALTH BOARD
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CREDENTIALING & LICENSING ASSOCIATE
Authorized Official - Prefix:
Authorized Official - First Name:ADRIAN
Authorized Official - Middle Name:A
Authorized Official - Last Name:MARCUS-FLORES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:510-485-5906
Mailing Address - Street 1:2920 INTERNATIONAL BLVD
Mailing Address - Street 2:ROOM 101
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94601-2228
Mailing Address - Country:US
Mailing Address - Phone:510-485-5948
Mailing Address - Fax:510-485-5949
Practice Address - Street 1:2950 INTERNATIONAL BLVD
Practice Address - Street 2:ROOM 101
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94601-2228
Practice Address - Country:US
Practice Address - Phone:510-485-5948
Practice Address - Fax:510-485-5949
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NATIVE AMERICAN HEALTH CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-10-16
Last Update Date:2022-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
CA140000155261Q00000X, 261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
No171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1689863516Medicaid
CAFHC11743FMedicaid
CAHAP11743FOtherSOFP
CAFHC11743FMedicaid
CA1619147030Medicare PIN