Provider Demographics
NPI:1669007977
Name:TULE RIVER INDIAN HEALTH CENTER, INC.
Entity type:Organization
Organization Name:TULE RIVER INDIAN HEALTH CENTER, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:STAFF ACCOUNTANT
Authorized Official - Prefix:
Authorized Official - First Name:SYLVIA
Authorized Official - Middle Name:
Authorized Official - Last Name:JIMENEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:559-791-2549
Mailing Address - Street 1:PO BOX 768
Mailing Address - Street 2:
Mailing Address - City:PORTERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:93258-0768
Mailing Address - Country:US
Mailing Address - Phone:559-784-2316
Mailing Address - Fax:559-791-2533
Practice Address - Street 1:380 N RESERVATION RD
Practice Address - Street 2:
Practice Address - City:PORTERVILLE
Practice Address - State:CA
Practice Address - Zip Code:93257-9673
Practice Address - Country:US
Practice Address - Phone:559-784-2316
Practice Address - Fax:559-791-2533
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TULE RIVER INDIAN HEALTH CENTER, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-03-06
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1972586972Medicaid
CA1669007977Medicaid