Organization
ROUND VALLEY INDIAN HEALTH CENTER, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
OTIS D BROTHERTON (EXECUTIVE DIRECTOR)
(707) 983-6181
Entity
Organization
Contact information
Practice address
24065 BIGGAR LANE, COVELO, CA 95428-0247
(707) 983-6404
(707) 983-6184
Mailing address
PO BOX 247, COVELO, CA 95428-0247
(707) 983-6404
(707) 983-6184
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
110000097
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
THP11697F
—
CA
Enumeration date
12/11/2006
Last updated
03/14/2024
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