Active NPI
Consolidated Tribal Health Project, Inc
- Community Health Clinic/Center
- Redwood Valley, CA
National Provider Identifier
1902913486
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community Health Clinic/Center
- License
- 44306
- Legal business name
- CONSOLIDATED TRIBAL HEALTH PROJECT, INC
- Practice address
- 6991 N State St
Redwood Valley, CA 95470-9629 - Phone
- (707) 485-5115
- Fax
- (707) 485-7837
- NPI assigned
- Aug 23, 2006
- Last updated
- Aug 22, 2020
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- George Provencher
- Title
- Executive Director
- Phone
- (707) 485-5115
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community Health Clinic/Center | 261QC1500X | 44306 | CA | Primary |
Addresses
Primary practice location
6991 N State St
Redwood Valley, CA 95470-9629
Mailing address
947 N Oak St
Ukiah, CA 95482-3905
Phone (707) 485-5115
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
NPI to CCN mapping 1
The Medicare certification numbers (CCNs) connected to NPI 1902913486. Details of each certification follow.
Federally qualified health center certification: CCN 751870
Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.
- Legal name
- CONSOLIDATED TRIBAL HEALTH PROJECT INC
- Certification status
- Active
- Provider type (POS)
- Federally qualified health center
- Participating since
- Sep 4, 2014
- Last certification
- Sep 4, 2014
- Ownership / control type
- For profit – corporation
- Facility address
- 6991 N State Street
Redwood Valley, CA 95470
National Provider Directory
National Provider Directory- Tax ID family
- Consol Tribal HLTH Project
Other organizations with this tax ID 2
Organizations that report the same tax identification number in the National Provider Directory.
-
- General Practice Dentistry
- Redwood Valley, CA
- NPI 1124046842
-
- General Practice Dentistry
- Redwood Valley, CA
- NPI 1215955935
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156291200000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1598054400000",
"number": "1902913486",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "947 N OAK ST",
"city": "UKIAH",
"state": "CA",
"postal_code": "954823905",
"telephone_number": "707-485-5115",
"fax_number": "707-485-7837"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6991 N STATE ST",
"city": "REDWOOD VALLEY",
"state": "CA",
"postal_code": "954709629",
"telephone_number": "707-485-5115",
"fax_number": "707-485-7837"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "CONSOLIDATED TRIBAL HEALTH PROJECT, INC",
"organizational_subpart": "NO",
"enumeration_date": "2006-08-23",
"last_updated": "2020-08-22",
"status": "A",
"authorized_official_last_name": "PROVENCHER",
"authorized_official_first_name": "GEORGE",
"authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
"authorized_official_telephone_number": "707-485-5115"
},
"taxonomies": [
{
"code": "261QC1500X",
"taxonomy_group": "",
"desc": "Clinic/Center, Community Health",
"state": "CA",
"license": "44306",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Redwood Valley, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.