Healthcare Provider Details

I. General information

NPI: 1730445347
Provider Name (Legal Business Name): COMMUNITY HOSPITAL ASSOCIATION, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/09/2012
Last Update Date: 04/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 PALO VERDE ROAD
BAGDAD AZ
86321
US

IV. Provider business mailing address

520 ROSE LN
WICKENBURG AZ
85390-1447
US

V. Phone/Fax

Practice location:
  • Phone: 928-633-6393
  • Fax:
Mailing address:
  • Phone: 928-684-4390
  • Fax: 928-684-5081

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. JAMES R SMITH
Title or Position: CFO
Credential: CPA
Phone: 928-684-4390