Healthcare Provider Details

I. General information

NPI: 1760666739
Provider Name (Legal Business Name): DHHS PHS NAIHS CHINLE COMPREHENSIVE HEALTH CARE FACILITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/26/2007
Last Update Date: 12/26/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

OFF HWY 191 & HOSPITAL ROAD
CHINLE AZ
86503
US

IV. Provider business mailing address

PO DRAWER PH
CHINLE AZ
86503
US

V. Phone/Fax

Practice location:
  • Phone: 928-674-7001
  • Fax: 928-674-7008
Mailing address:
  • Phone: 928-674-7001
  • Fax: 928-674-7008

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. PATRICK J. YAZZIE
Title or Position: BUSINESS OFFICE MANAGER
Credential:
Phone: 928-674-7030