Basic Information
| Provider Information | |||||||||
| NPI: | 1922090588 | ||||||||
| EntityType: | 2 | ||||||||
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| 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: | 5305345394 | ||||||||
| FaxNumber: | 5305343820 | ||||||||
| Practice Location | |||||||||
| Address1: | 2145 5TH AVE | ||||||||
| Address2: | |||||||||
| City: | OROVILLE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 95965 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5305345394 | ||||||||
| FaxNumber: | 5305343820 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/19/2005 | ||||||||
| LastUpdateDate: | 08/03/2018 | ||||||||
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| AuthorizedOfficialLastName: | HUNZEKER | ||||||||
| AuthorizedOfficialFirstName: | MARIA | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | EXECUTIVE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 5305345394 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QC1500X | 230000003 | CA | N | Ambulatory Health Care Facilities | Clinic/Center | Community Health | 261QF0400X | Y | Ambulatory Health Care Facilities | Clinic/Center | Federally Qualified Health Center (FQHC) |
ID Information
| ID | Type | State | Issuer | Description | BCP70041G | 01 | CA | BREAST CANCER PROGRAM | OTHER | HAP70041G | 01 | CA | FAMILY PACT | OTHER | THP70041G | 05 | CA | MEDICAID |