Healthcare Provider Details

I. General information

NPI: 1891776902
Provider Name (Legal Business Name): GILA RIVER HEALTH CARE CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

565 W. SEED FARM RD
SACATON AZ
85247
US

IV. Provider business mailing address

PO BOX 2176
SACATON AZ
85247-2176
US

V. Phone/Fax

Practice location:
  • Phone: 602-271-7903
  • Fax: 602-271-7970
Mailing address:
  • Phone: 602-271-7903
  • Fax: 602-271-7970

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QE0700X
TaxonomyEnd-Stage Renal Disease (ESRD) Treatment Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. JAN ANDERSON
Title or Position: INTERIM DIALYSIS ADMINISTRATOR
Credential:
Phone: 602-271-7901