Provider Demographics
NPI:1447374012
Name:TOIYABE INDIAN HEALTH PROJECT, INC
Entity type:Organization
Organization Name:TOIYABE INDIAN HEALTH PROJECT, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:INTERIM-CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:EARL
Authorized Official - Middle Name:W
Authorized Official - Last Name:LENT
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:760-873-8464
Mailing Address - Street 1:250 N SEE VEE LANE
Mailing Address - Street 2:
Mailing Address - City:BISHOP
Mailing Address - State:CA
Mailing Address - Zip Code:93514-8130
Mailing Address - Country:US
Mailing Address - Phone:760-873-8464
Mailing Address - Fax:760-873-3935
Practice Address - Street 1:44-B TU SU LANE
Practice Address - Street 2:
Practice Address - City:BISHOP
Practice Address - State:CA
Practice Address - Zip Code:93514-8058
Practice Address - Country:US
Practice Address - Phone:760-873-7611
Practice Address - Fax:760-873-3935
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
Last Update Date:2024-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAEXEMPT261QE0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAMTN00253FMedicaid
CACDC02836FMedicaid
CA05-2836Medicare ID - Type UnspecifiedMEDICARE PROVIDER #
CACDC02836FMedicaid