Provider Demographics
NPI:1902025059
Name:CENTRAL VALLEY INDIAN HEALTH INC
Entity Type:Organization
Organization Name:CENTRAL VALLEY INDIAN HEALTH INC
Other - Org Name:CENTRAL VALLEY INDIAN HEALTH CLINIC PRATHER
Other - Org Type:Other Name
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:A
Authorized Official - Last Name:RAMSEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-299-2578
Mailing Address - Street 1:2740 HERNDON AVE
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93611-6813
Mailing Address - Country:US
Mailing Address - Phone:559-299-2578
Mailing Address - Fax:559-299-1421
Practice Address - Street 1:29369 AUBERRY RD
Practice Address - Street 2:102
Practice Address - City:PRATHER
Practice Address - State:CA
Practice Address - Zip Code:93651-9784
Practice Address - Country:US
Practice Address - Phone:559-855-5390
Practice Address - Fax:559-299-1421
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-25
Last Update Date:2023-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA040000392261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ89811ZMedicare UPIN