Basic Information
Provider Information
NPI: 1922090489
EntityType: 2
ReplacementNPI:  
OrganizationName: FEATHER RIVER TRIBAL HEALTH, INC.
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Mailing Information
Address1: 2145 5TH AVE
Address2:  
City: OROVILLE
State: CA
PostalCode: 959655870
CountryCode: US
TelephoneNumber: 5305343793
FaxNumber: 5305343820
Practice Location
Address1: 555 W ONSTOTT RD
Address2:  
City: YUBA CITY
State: CA
PostalCode: 95993
CountryCode: US
TelephoneNumber: 5307518454
FaxNumber: 5307518456
Other Information
ProviderEnumerationDate: 08/19/2005
LastUpdateDate: 08/03/2018
NPIDeactivationReasonCode:  
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AuthorizedOfficialLastName: HUNZEKER
AuthorizedOfficialFirstName: MARIA
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AuthorizedOfficialTitleorPosition: EXECUTIVE DIRECTOR
AuthorizedOfficialTelephone: 5305343793
IsSoleProprietor:  
IsOrganizationSubpart: N
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Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
261QC1500X2300000265CAN Ambulatory Health Care FacilitiesClinic/CenterCommunity Health
261QF0400X  Y Ambulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)

ID Information
IDTypeStateIssuerDescription
BCP70683F01CABREAST CANCER PROGRAMOTHER
THP70683F05CA MEDICAID


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