Provider Demographics
NPI:1942435946
Name:CHAPA-DE INDIAN HEALTH PROGRAM INC
Entity Type:Organization
Organization Name:CHAPA-DE INDIAN HEALTH PROGRAM INC
Other - Org Name:CHAPA-DE INDIAN HEALTH PROGRAM PHARMACY-GRASS VALLEY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:530-887-2800
Mailing Address - Street 1:1350 E MAIN ST
Mailing Address - Street 2:PHARMACY DEPT
Mailing Address - City:GRASS VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95945-5208
Mailing Address - Country:US
Mailing Address - Phone:530-477-5968
Mailing Address - Fax:530-477-8738
Practice Address - Street 1:1350 E MAIN ST
Practice Address - Street 2:PHARMACY DEPT
Practice Address - City:GRASS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95945-5208
Practice Address - Country:US
Practice Address - Phone:530-477-5968
Practice Address - Fax:530-477-8738
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-19
Last Update Date:2017-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY49917332800000X
333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332800000XSuppliersIndian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1942435946Medicaid
2120323OtherPK