Healthcare Provider Details

I. General information

NPI: 1447843651
Provider Name (Legal Business Name): TONTO APACHE HEALTHCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/18/2021
Last Update Date: 08/26/2025
Certification Date: 07/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 TONTO APACHE RESERVATION
PAYSON AZ
85541-5556
US

IV. Provider business mailing address

40 TONTO APACHE RESERVATION
PAYSON AZ
85541
US

V. Phone/Fax

Practice location:
  • Phone: 928-474-5000
  • Fax:
Mailing address:
  • Phone: 928-472-3906
  • Fax: 928-474-3666

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number StateNULL

VIII. Authorized Official

Name: LISA CARRASCO
Title or Position: ADMINISTRATOR
Credential: NURSE PRACTITIONER
Phone: 928-472-3906