1346377926 NPI number — KAYENTA ALTERNATIVE RURAL HOSPITAL

Table of content: (NPI 1346377926)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346377926 NPI number — KAYENTA ALTERNATIVE RURAL HOSPITAL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KAYENTA ALTERNATIVE RURAL HOSPITAL
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:
6
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:
1346377926
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/31/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
KAYENTA INDIAN HEALTH CTR
Provider Second Line Business Mailing Address:
PO BOX 31001-0655
Provider Business Mailing Address City Name:
PASADENA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91110-0655
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
928-672-3029
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
HWY 98 AND NAVAJO RT 16
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SHONTO
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
86054
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
928-672-3029
Provider Business Practice Location Address Fax Number:
928-672-3005
Provider Enumeration Date:
02/28/2007

Additional Information

Authorized Official

Authorized Official Last Name:
KELEWOOD
Authorized Official First Name:
TERRI
Authorized Official Middle Name:
MAE
Authorized Official Title or Position:
BUSINESS OFFICE MANAGER
Authorized Official Telephone Number:
928-697-5059

Provider Taxonomy Codes

  • Taxonomy code: 332800000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 060690 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1990677 . This is a "PK" identifier . This identifiers is of the category "OTHER".




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