Provider Demographics
NPI:1265567127
Name:NORTHERN VALLEY INDIAN HEALTH, INC
Entity type:Organization
Organization Name:NORTHERN VALLEY INDIAN HEALTH, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:FISCAL MANGAGEMENT DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LARISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:TAMBLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:530-934-9293
Mailing Address - Street 1:207 N BUTTE ST
Mailing Address - Street 2:
Mailing Address - City:WILLOWS
Mailing Address - State:CA
Mailing Address - Zip Code:95988-2803
Mailing Address - Country:US
Mailing Address - Phone:530-934-9293
Mailing Address - Fax:530-934-2204
Practice Address - Street 1:845 W EAST AVE
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95926-2002
Practice Address - Country:US
Practice Address - Phone:530-896-9400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-22
Last Update Date:2013-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
CATHP70710FMedicaid
CATHP70710FMedicaid