1184171894 NPI number — CHINLE COMPREHENSIVE HEALTH CARE FACILITY

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184171894 NPI number — CHINLE COMPREHENSIVE HEALTH CARE FACILITY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHINLE COMPREHENSIVE HEALTH CARE FACILITY
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1184171894
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/10/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX PH
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHINLE
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
86503-8000
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
928-674-7001
Provider Business Mailing Address Fax Number:
928-674-7849

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
HIGHWAY 191, HOSPITAL TURNOFF
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHINLE
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
86503
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
928-674-7001
Provider Business Practice Location Address Fax Number:
928-674-7849
Provider Enumeration Date:
09/10/2016

Additional Information

Authorized Official

Authorized Official Last Name:
LLOYD
Authorized Official First Name:
WALTER
Authorized Official Middle Name:
Authorized Official Title or Position:
CHEIF PHARMACIST/PHARMACY DIRECTOR
Authorized Official Telephone Number:
928-674-7502

Provider Taxonomy Codes

  • Taxonomy code: 282NR1301X , with the licence number:  RP00008444 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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