Provider Demographics
NPI:1841430436
Name:GILA COUNTY
Entity type:Organization
Organization Name:GILA COUNTY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHAIRMAN, BOARD OF SUPERVISORS
Authorized Official - Prefix:MS
Authorized Official - First Name:SHIRLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:DAWSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-425-3231
Mailing Address - Street 1:1400 E ASH ST
Mailing Address - Street 2:
Mailing Address - City:GLOBE
Mailing Address - State:AZ
Mailing Address - Zip Code:85501-1483
Mailing Address - Country:US
Mailing Address - Phone:928-425-3231
Mailing Address - Fax:
Practice Address - Street 1:5515 S APACHE AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:GLOBE
Practice Address - State:AZ
Practice Address - Zip Code:85501-4428
Practice Address - Country:US
Practice Address - Phone:928-402-8664
Practice Address - Fax:928-425-9468
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-23
Last Update Date:2009-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
No251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ925886OtherAHCCCS