Provider Demographics
NPI:1194340794
Name:GREENVILLE RANCHERIA
Entity type:Organization
Organization Name:GREENVILLE RANCHERIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:ANTONIA
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:HAYWORTH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:530-528-8600
Mailing Address - Street 1:PO BOX 279
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95947-0279
Mailing Address - Country:US
Mailing Address - Phone:530-528-3481
Mailing Address - Fax:
Practice Address - Street 1:13545 SAINT MARYS AVE
Practice Address - Street 2:
Practice Address - City:RED BLUFF
Practice Address - State:CA
Practice Address - Zip Code:96080-8884
Practice Address - Country:US
Practice Address - Phone:530-528-8600
Practice Address - Fax:530-528-8612
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-10
Last Update Date:2020-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health