Basic Information
| Provider Information | |||||||||
| NPI: | 1003826009 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | CONSOLIDATED TRIBAL HEALTH PROJECT, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 387 | ||||||||
| Address2: | |||||||||
| City: | CALPELLA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 954180387 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7074855115 | ||||||||
| FaxNumber: | 7074857792 | ||||||||
| Practice Location | |||||||||
| Address1: | 6991 N STATE ST | ||||||||
| Address2: | |||||||||
| City: | REDWOOD VALLEY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 954709629 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7074855115 | ||||||||
| FaxNumber: | 7074675698 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/09/2006 | ||||||||
| LastUpdateDate: | 08/23/2021 | ||||||||
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| AuthorizedOfficialLastName: | STEWART | ||||||||
| AuthorizedOfficialFirstName: | JAMES | ||||||||
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| AuthorizedOfficialTitleorPosition: | EXECUTIVE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 7074675620 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 08/23/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QH0100X | 110000210 | CA | Y | Ambulatory Health Care Facilities | Clinic/Center | Health Service |
ID Information
| ID | Type | State | Issuer | Description | HAP70442F | 01 | CA | FAMILY PACT | OTHER | THP70442F | 05 | CA | MEDICAID | EAP70442F | 01 | CA | EAPC | OTHER |