Basic Information
| Provider Information | |||||||||
| NPI: | 1598331753 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | KLAMATH TRIBAL HEALTH AND FAMILY SERVICES | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3949 S 6TH ST | ||||||||
| Address2: | |||||||||
| City: | KLAMATH FALLS | ||||||||
| State: | OR | ||||||||
| PostalCode: | 976034746 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5418821487 | ||||||||
| FaxNumber: | 5418805590 | ||||||||
| Practice Location | |||||||||
| Address1: | 635 MAIN ST | ||||||||
| Address2: | |||||||||
| City: | KLAMATH FALLS | ||||||||
| State: | OR | ||||||||
| PostalCode: | 976016007 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5418841851 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/28/2021 | ||||||||
| LastUpdateDate: | 05/28/2021 | ||||||||
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| AuthorizedOfficialLastName: | RICH | ||||||||
| AuthorizedOfficialFirstName: | CHARISE | ||||||||
| AuthorizedOfficialMiddleName: | RILEY | ||||||||
| AuthorizedOfficialTitleorPosition: | BUSINESS OFFICE MANAGER - INTERIM | ||||||||
| AuthorizedOfficialTelephone: | 5418821487 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 05/28/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251B00000X | Y | Agencies | Case Management |
No ID Information.