Provider Demographics
NPI:1295752384
Name:NORTHERN VALLEY INDIAN HEALTH INC
Entity type:Organization
Organization Name:NORTHERN VALLEY INDIAN HEALTH INC
Other - Org Name:
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 1:207 N BUTTE ST
Practice Address - Street 2:
Practice Address - City:WILLOWS
Practice Address - State:CA
Practice Address - Zip Code:95988-2803
Practice Address - Country:US
Practice Address - Phone:530-934-9293
Practice Address - Fax:530-934-2204
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-16
Last Update Date:2013-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA230000212261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA051924Medicare ID - Type UnspecifiedPROVIDER NUMBER