Provider Demographics
NPI:1811185259
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:REVENUE CYCLE SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:JERUSHA
Authorized Official - Middle Name:
Authorized Official - Last Name:NORMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:510-485-5941
Mailing Address - Street 1:3124 INTERNATIONAL BLVD
Mailing Address - Street 2:ROOM 314
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94601-2228
Mailing Address - Country:US
Mailing Address - Phone:510-434-5379
Mailing Address - Fax:510-261-1841
Practice Address - Street 1:160 CAPP ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94110
Practice Address - Country:US
Practice Address - Phone:415-621-1170
Practice Address - Fax:415-255-7527
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NATIVE AMERICAN HEALTH CENTER INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-10-10
Last Update Date:2018-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA220000207261QF0400X
CA261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAEAP11429FOtherEAPC
CAHAP11429FOtherSOFP
CAFHC11429FMedicaid
CA1811185259Medicaid
CAHAP11429FOtherSOFP
CA1669642914Medicare PIN