Provider Demographics
NPI:1043427388
Name:COUNTY OF TEHAMA
Entity type:Organization
Organization Name:COUNTY OF TEHAMA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JAYME
Authorized Official - Middle Name:S
Authorized Official - Last Name:BOTTKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:530-527-8491
Mailing Address - Street 1:PO BOX 400
Mailing Address - Street 2:
Mailing Address - City:RED BLUFF
Mailing Address - State:CA
Mailing Address - Zip Code:96080-0400
Mailing Address - Country:US
Mailing Address - Phone:530-527-8491
Mailing Address - Fax:530-427-0240
Practice Address - Street 1:1850 WALNUT ST
Practice Address - Street 2:
Practice Address - City:RED BLUFF
Practice Address - State:CA
Practice Address - Zip Code:96080-3611
Practice Address - Country:US
Practice Address - Phone:530-527-8491
Practice Address - Fax:530-527-0240
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COUNTY OF TEHAMA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-05-17
Last Update Date:2024-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CABCP13980FMedicaid
CAGR0087850Medicaid
CARHM13980FMedicaid
CAHAP13980FMedicaid
CALAB44254FMedicaid
C16305OtherRAILROAD MEDICARE
CAGR0087850Medicaid
058910Medicare ID - Type UnspecifiedRIVERBEND
ZZZ10659ZMedicare ID - Type Unspecified