Provider Demographics
NPI:1649441502
Name:FALLON PAIUTE SHOSHONE TRIBE
Entity type:Organization
Organization Name:FALLON PAIUTE SHOSHONE TRIBE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:HUMAN SERVICES DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:BONNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:RUSHFORD
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:775-423-1215
Mailing Address - Street 1:565 RIO VISTA ST
Mailing Address - Street 2:
Mailing Address - City:FALLON
Mailing Address - State:NV
Mailing Address - Zip Code:89406-6415
Mailing Address - Country:US
Mailing Address - Phone:775-423-1132
Mailing Address - Fax:775-423-3205
Practice Address - Street 1:2101 AGENCY RD
Practice Address - Street 2:
Practice Address - City:FALLON
Practice Address - State:NV
Practice Address - Zip Code:89406-7142
Practice Address - Country:US
Practice Address - Phone:775-423-1132
Practice Address - Fax:775-423-3205
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FALLON PAIUTE SHOSHONE TRIBE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-03-19
Last Update Date:2008-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty