Provider Demographics
NPI:1760495485
Name:FEATHER RIVER TRIBAL HEALTH INC
Entity Type:Organization
Organization Name:FEATHER RIVER TRIBAL HEALTH INC
Other - Org Name:FEATHER RIVER TRIBAL HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXEC DIR
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:
Authorized Official - Last Name:HUNZEKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:530-534-5394
Mailing Address - Street 1:2145 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:OROVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95965-5870
Mailing Address - Country:US
Mailing Address - Phone:530-534-5394
Mailing Address - Fax:530-534-3820
Practice Address - Street 1:2145 5TH AVE
Practice Address - Street 2:
Practice Address - City:OROVILLE
Practice Address - State:CA
Practice Address - Zip Code:95965-5870
Practice Address - Country:US
Practice Address - Phone:530-534-5394
Practice Address - Fax:530-534-3820
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-14
Last Update Date:2016-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332800000X, 3336C0002X
CAPHY474533336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332800000XSuppliersIndian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
No3336C0002XSuppliersPharmacyClinic Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2000654OtherPK
CAPHA457370Medicaid