Healthcare Provider Details

I. General information

NPI: 1841430436
Provider Name (Legal Business Name): GILA COUNTY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/23/2009
Last Update Date: 02/23/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5515 S APACHE AVE SUITE 200
GLOBE AZ
85501-4428
US

IV. Provider business mailing address

1400 E ASH ST
GLOBE AZ
85501-1483
US

V. Phone/Fax

Practice location:
  • Phone: 928-402-8664
  • Fax: 928-425-9468
Mailing address:
  • Phone: 928-425-3231
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. SHIRLEY DAWSON
Title or Position: CHAIRMAN, BOARD OF SUPERVISORS
Credential:
Phone: 928-425-3231