Healthcare Provider Details

I. General information

NPI: 1396761565
Provider Name (Legal Business Name): DHHS PHS NAIHS CHINLE COMPREHENSIVE HEALTH CARE FACILITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2006
Last Update Date: 01/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

NAVAJO ROUTE 4
PINON AZ
86510
US

IV. Provider business mailing address

NAVAJO ROUTE 4
PINON AZ
86510
US

V. Phone/Fax

Practice location:
  • Phone: 928-725-3220
  • Fax: 928-725-3613
Mailing address:
  • Phone: 928-725-3220
  • Fax: 928-725-3613

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number
License Number State

VIII. Authorized Official

Name: MR. PATRICK J. YAZZIE
Title or Position: BUSINESS OFFICE MANAGER
Credential:
Phone: 928-674-7030