1760798680 NPI number — NORTH COUNTRY HEALTHCARE, INC.

Table of content: (NPI 1760798680)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760798680 NPI number — NORTH COUNTRY HEALTHCARE, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTH COUNTRY HEALTHCARE, INC.
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:
1760798680
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/30/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 3630
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FLAGSTAFF
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
86003-3630
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
928-522-9400
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2585 S. MIRACLE MILE
Provider Second Line Business Practice Location Address:
STE 116
Provider Business Practice Location Address City Name:
BULLHEAD
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
86442
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
928-704-1221
Provider Business Practice Location Address Fax Number:
928-704-1243
Provider Enumeration Date:
08/30/2010

Additional Information

Authorized Official

Authorized Official Last Name:
NEWLAND
Authorized Official First Name:
ANNE
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
928-522-9400

Provider Taxonomy Codes

  • Taxonomy code: 261QF0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QM1300X , 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)

  • Identifier: 576587 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".




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