Healthcare Provider Details

I. General information

NPI: 1184998635
Provider Name (Legal Business Name): DHHS IHS PHOENIX AREA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/01/2012
Last Update Date: 03/01/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HIGHWAY 264 MILEPOST 388
POLACCA AZ
86042-4000
US

IV. Provider business mailing address

HIGHWAY 264 MILEPOST 388 PO BOX 4000
POLACCA AZ
86042-4000
US

V. Phone/Fax

Practice location:
  • Phone: 928-737-6000
  • Fax: 928-737-6080
Mailing address:
  • Phone: 928-737-6000
  • Fax: 928-737-6080

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License Number
License Number State

VIII. Authorized Official

Name: DEALVA HONAHNIE
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 928-737-6000