1528318227 NPI number — COLORADO RIVER INDIAN TRIBES

Table of content: (NPI 1528318227)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528318227 NPI number — COLORADO RIVER INDIAN TRIBES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COLORADO RIVER INDIAN TRIBES
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:
1528318227
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/14/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12302 KENNEDY DRIVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PARKER
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85344
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
928-669-6577
Provider Business Mailing Address Fax Number:
928-669-8881

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1321 MOHAVE AVE
Provider Second Line Business Practice Location Address:
SECOND FLOOR
Provider Business Practice Location Address City Name:
PARKER
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85344
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
928-575-4424
Provider Business Practice Location Address Fax Number:
928-669-8881
Provider Enumeration Date:
09/11/2012

Additional Information

Authorized Official

Authorized Official Last Name:
JOHNSON HARPER
Authorized Official First Name:
ANDREA
Authorized Official Middle Name:
LA ROSE
Authorized Official Title or Position:
DHSS EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
928-669-6577

Provider Taxonomy Codes

  • Taxonomy code: 343900000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1083887574 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 536451 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".




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