Healthcare Provider Details

I. General information

NPI: 1760483994
Provider Name (Legal Business Name): COMMUNITY HEALTHCARE OF DOUGLAS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2174 W OAK AVE
DOUGLAS AZ
85607-6003
US

IV. Provider business mailing address

2174 W OAK AVE
DOUGLAS AZ
85607-6003
US

V. Phone/Fax

Practice location:
  • Phone: 520-364-7931
  • Fax: 520-364-2551
Mailing address:
  • Phone: 520-364-7931
  • Fax: 520-364-2551

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License NumberH0015
License Number StateAZ

VIII. Authorized Official

Name: MS. ANNIE L. BENSON
Title or Position: COO
Credential:
Phone: 520-364-7931