1487876991 NPI number — NAVAJO REGIONAL BEHAVIORAL HEALTH CENTER - OUTPATIENT

Table of content: (NPI 1487876991)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487876991 NPI number — NAVAJO REGIONAL BEHAVIORAL HEALTH CENTER - OUTPATIENT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NAVAJO REGIONAL BEHAVIORAL HEALTH CENTER - OUTPATIENT
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:
1487876991
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/10/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1830
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SHIPROCK
Provider Business Mailing Address State Name:
NM
Provider Business Mailing Address Postal Code:
87420-1830
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
505-368-1438
Provider Business Mailing Address Fax Number:
505-368-1461

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
PINON & COTTONWOOD DR BUILDING #2301
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SHIPROCK
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
87420
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
505-368-1438
Provider Business Practice Location Address Fax Number:
505-368-1461
Provider Enumeration Date:
05/03/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BROWN
Authorized Official First Name:
SIDNEY
Authorized Official Middle Name:
Authorized Official Title or Position:
BEHAVIORAL HEALTH DIRECTOR
Authorized Official Telephone Number:
505-368-1438

Provider Taxonomy Codes

  • Taxonomy code: 101YA0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 80403069 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com