1376664193 NPI number — COMMUNITY HOSPITAL ASSOCIATION, INC., DBA WICKENBURG COMMUNITY HOSPITA

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 1376664193 NPI number — COMMUNITY HOSPITAL ASSOCIATION, INC., DBA WICKENBURG COMMUNITY HOSPITA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COMMUNITY HOSPITAL ASSOCIATION, INC., DBA WICKENBURG COMMUNITY HOSPITA
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:
1376664193
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
520 ROSE LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WICKENBURG
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85390-1447
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
928-684-5421
Provider Business Mailing Address Fax Number:
928-684-5499

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
520 ROSE LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WICKENBURG
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85390-1447
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
928-684-5421
Provider Business Practice Location Address Fax Number:
928-684-5499
Provider Enumeration Date:
04/02/2007

Additional Information

Authorized Official

Authorized Official Last Name:
DECKER
Authorized Official First Name:
DALE
Authorized Official Middle Name:
A
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
928-684-5421

Provider Taxonomy Codes

  • Taxonomy code: 282NR1301X , with the licence number:  3488 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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