Provider Demographics
NPI:1891762985
Name:PIT RIVER HEALTH SERVICE, INC.
Entity Type:Organization
Organization Name:PIT RIVER HEALTH SERVICE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS SERVICES MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BRANDI
Authorized Official - Middle Name:
Authorized Official - Last Name:GIBBS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:530-335-5090
Mailing Address - Street 1:36977 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:BURNEY
Mailing Address - State:CA
Mailing Address - Zip Code:96013-4067
Mailing Address - Country:US
Mailing Address - Phone:530-335-5090
Mailing Address - Fax:530-335-5241
Practice Address - Street 1:36977 PARK AVE
Practice Address - Street 2:
Practice Address - City:BURNEY
Practice Address - State:CA
Practice Address - Zip Code:96013
Practice Address - Country:US
Practice Address - Phone:530-335-5090
Practice Address - Fax:530-335-5241
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-07
Last Update Date:2023-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA230000179261QC1500X, 261QR1300X
332800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
No332800000XSuppliersIndian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CATHP00001FMedicaid
053845Medicare ID - Type Unspecified