Provider Demographics
NPI:1316571441
Name:CANONCITO BAND OF NAVAJOS HEALTH CENTER, INC.
Entity type:Organization
Organization Name:CANONCITO BAND OF NAVAJOS HEALTH CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FINANCE DIRECTOR-CONTROLLER
Authorized Official - Prefix:
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:M
Authorized Official - Last Name:STRZEPEK BROWNING
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:505-908-2380
Mailing Address - Street 1:PO BOX 3338
Mailing Address - Street 2:
Mailing Address - City:TOHAJIILEE
Mailing Address - State:NM
Mailing Address - Zip Code:87026-3338
Mailing Address - Country:US
Mailing Address - Phone:505-908-2380
Mailing Address - Fax:
Practice Address - Street 1:129 MEDICINE HORSE DR
Practice Address - Street 2:
Practice Address - City:TOHAJIILEE
Practice Address - State:NM
Practice Address - Zip Code:87026-3338
Practice Address - Country:US
Practice Address - Phone:505-908-2307
Practice Address - Fax:505-908-2310
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-27
Last Update Date:2020-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)