Healthcare Provider Details

I. General information

NPI: 1154989168
Provider Name (Legal Business Name): COMMUNITY HOSPITAL ASSOCIATION, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2019
Last Update Date: 06/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26750B S. SANTA FE RD.
CONGRESS AZ
85332
US

IV. Provider business mailing address

520 ROSE LN
WICKENBURG AZ
85390-1447
US

V. Phone/Fax

Practice location:
  • Phone: 928-668-5421
  • Fax:
Mailing address:
  • Phone: 928-668-5502
  • Fax: 928-427-6369

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: CHERYL ANNE BROUMEL
Title or Position: CLINIC RESOURCE MANAGER
Credential:
Phone: 928-668-1845