Provider Demographics
NPI:1316620438
Name:DHHS PHS NAIHS CHINLE COMPREHENSIVE HEALTH CARE FACILITY
Entity type:Organization
Organization Name:DHHS PHS NAIHS CHINLE COMPREHENSIVE HEALTH CARE FACILITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:J
Authorized Official - Last Name:YAZZIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-674-7030
Mailing Address - Street 1:PO BOX C21
Mailing Address - Street 2:
Mailing Address - City:TSAILE
Mailing Address - State:AZ
Mailing Address - Zip Code:86556
Mailing Address - Country:US
Mailing Address - Phone:928-724-3612
Mailing Address - Fax:928-724-3671
Practice Address - Street 1:N 191 HIGH SCHOOL ROAD
Practice Address - Street 2:
Practice Address - City:ROCK POINT
Practice Address - State:AZ
Practice Address - Zip Code:86545
Practice Address - Country:US
Practice Address - Phone:928-659-4282
Practice Address - Fax:928-659-4115
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DHHS PHS NAIHS CHINLE COMPREHENSIVE HEALTH CARE FACILITY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-08-08
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental