Provider Demographics
NPI:1154989168
Name:COMMUNITY HOSPITAL ASSOCIATION, INC.
Entity type:Organization
Organization Name:COMMUNITY HOSPITAL ASSOCIATION, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC RESOURCE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:BROUMEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-668-1845
Mailing Address - Street 1:520 ROSE LN
Mailing Address - Street 2:
Mailing Address - City:WICKENBURG
Mailing Address - State:AZ
Mailing Address - Zip Code:85390-1447
Mailing Address - Country:US
Mailing Address - Phone:928-668-5502
Mailing Address - Fax:928-427-6369
Practice Address - Street 1:26750B S. SANTA FE RD.
Practice Address - Street 2:
Practice Address - City:CONGRESS
Practice Address - State:AZ
Practice Address - Zip Code:85332
Practice Address - Country:US
Practice Address - Phone:928-668-5421
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COMMUNITY HOSPITAL ASSOCIATION, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-06-04
Last Update Date:2019-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0002XSuppliersPharmacyClinic Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ950240Medicaid