Healthcare Provider Details

I. General information

NPI: 1609328194
Provider Name (Legal Business Name): AK-CHIN HEALTH & HUMAN SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/31/2016
Last Update Date: 10/31/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

48227 W FARRELL RD
MARICOPA AZ
85139-3806
US

IV. Provider business mailing address

48227 W FARRELL RD
MARICOPA AZ
85139-3806
US

V. Phone/Fax

Practice location:
  • Phone: 520-568-1090
  • Fax: 520-568-1096
Mailing address:
  • Phone: 520-568-1090
  • Fax: 520-568-1096

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. BRIAN HOLIDAY
Title or Position: DIRECTOR
Credential: LMSW
Phone: 520-568-1090