Healthcare Provider Details

I. General information

NPI: 1659317022
Provider Name (Legal Business Name): COUNTY OF YAVAPAI
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2006
Last Update Date: 02/10/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1090 COMMERCE DR
PRESCOTT AZ
86305-3700
US

IV. Provider business mailing address

1090 COMMERCE DR
PRESCOTT AZ
86305-3700
US

V. Phone/Fax

Practice location:
  • Phone: 928-583-1000
  • Fax: 866-323-8458
Mailing address:
  • Phone: 928-583-1000
  • Fax: 866-323-8458

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License NumberOTC3512
License Number StateAZ

VIII. Authorized Official

Name: SHARON RICKMAN
Title or Position: EXECITUVE DIRECTOR
Credential:
Phone: 928-442-5285