Provider Demographics
NPI:1861661365
Name:HUPA HEALTH ASSOCIATION INC AMBULANCE
Entity Type:Organization
Organization Name:HUPA HEALTH ASSOCIATION INC AMBULANCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:EMMETT
Authorized Official - Middle Name:
Authorized Official - Last Name:CHASE
Authorized Official - Suffix:
Authorized Official - Credentials:CEO
Authorized Official - Phone:530-625-4261
Mailing Address - Street 1:PO BOX 1288
Mailing Address - Street 2:1200 AIRPORT RD
Mailing Address - City:HOOPA
Mailing Address - State:CA
Mailing Address - Zip Code:95546-1288
Mailing Address - Country:US
Mailing Address - Phone:530-625-4261
Mailing Address - Fax:530-625-9308
Practice Address - Street 1:535 AIRPORT RD
Practice Address - Street 2:
Practice Address - City:HOOPA
Practice Address - State:CA
Practice Address - Zip Code:95546-9615
Practice Address - Country:US
Practice Address - Phone:530-625-4261
Practice Address - Fax:530-625-9308
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:K'IMAW MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-02-28
Last Update Date:2019-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAEXEMPT INDIAN TRIBE261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ84024ZMedicaid
CAZZZ84024ZMedicaid