Healthcare Provider Details

I. General information

NPI: 1639334576
Provider Name (Legal Business Name): GILA HEALTH RESOURCES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2008
Last Update Date: 07/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 BURRO ALY
MORENCI AZ
85540-9647
US

IV. Provider business mailing address

PO BOX 218
MORENCI AZ
85540-0218
US

V. Phone/Fax

Practice location:
  • Phone: 928-865-7505
  • Fax: 928-865-7571
Mailing address:
  • Phone: 928-865-7505
  • Fax: 928-865-7571

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License NumberOTC-3507
License Number StateAZ

VIII. Authorized Official

Name: SHARON A FARRINGTON
Title or Position: ADMINISTRATOR
Credential:
Phone: 928-865-7505