Provider Demographics
NPI:1720084999
Name:REHOBOTH MCKINLEY CHRISTIAN HEALTH CARE SERVICES, INC.
Entity type:Organization
Organization Name:REHOBOTH MCKINLEY CHRISTIAN HEALTH CARE SERVICES, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:WAYNE
Authorized Official - Middle Name:
Authorized Official - Last Name:GILLIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-863-7004
Mailing Address - Street 1:1901 REDROCK DRIVE
Mailing Address - Street 2:
Mailing Address - City:GALLUP
Mailing Address - State:NM
Mailing Address - Zip Code:87301-5683
Mailing Address - Country:US
Mailing Address - Phone:505-863-7000
Mailing Address - Fax:
Practice Address - Street 1:1901 REDROCK DRIVE
Practice Address - Street 2:
Practice Address - City:GALLUP
Practice Address - State:NM
Practice Address - Zip Code:87301-5683
Practice Address - Country:US
Practice Address - Phone:505-863-7000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MCKINLEY CHRISTIAN HEALTH CARE SERVICES INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-06-22
Last Update Date:2024-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
No275N00000XHospital UnitsMedicare Defined Swing Bed Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM00000331Medicaid
IA0718791Medicaid
CO95200382Medicaid
NMNM000018OtherBCBS / FACILITY
ALREH0038NMedicaid
AR112866105Medicaid
GA000348433XMedicaid
ID002920700Medicaid
201078960OtherPRESBYTERIAN / FACILITY
FL905686600Medicaid
AKHS432IP-HS432OPMedicaid
CAXHSP33263/XHSP43263Medicaid
NM00331Medicaid
AZ020876Medicaid
X002467OtherCHAMPUS / FACILITY
CO95200382Medicaid
ID002920700Medicaid
ID002920700Medicaid