Provider Demographics
NPI:1417153685
Name:TOHONO O'ODHAM NATION - DIVISION OF BEHAVIORAL HEALTH
Entity type:Organization
Organization Name:TOHONO O'ODHAM NATION - DIVISION OF BEHAVIORAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHAIRMAN
Authorized Official - Prefix:MR
Authorized Official - First Name:NED
Authorized Official - Middle Name:
Authorized Official - Last Name:NORRIS
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:520-383-2028
Mailing Address - Street 1:PO BOX 810
Mailing Address - Street 2:HEALTH & HUMAN SERVICE COMPLEX - HIGHWAY 86
Mailing Address - City:SELLS
Mailing Address - State:AZ
Mailing Address - Zip Code:85634-0810
Mailing Address - Country:US
Mailing Address - Phone:520-383-6165
Mailing Address - Fax:520-383-5433
Practice Address - Street 1:HIGHWAY 86 - SELLS BUSINESS LOOP
Practice Address - Street 2:HIGHWAY 86 - SELLS BUSINESS LOOP
Practice Address - City:SELLS
Practice Address - State:AZ
Practice Address - Zip Code:85634-0810
Practice Address - Country:US
Practice Address - Phone:520-383-6165
Practice Address - Fax:520-383-5433
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ630972Medicaid