Healthcare Provider Details

I. General information

NPI: 1033437884
Provider Name (Legal Business Name): GILA RIVER HEALTH CARE CORPORTION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2010
Last Update Date: 05/04/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

483 W. SEED FARM RD. CREDENTIALING
SACATON AZ
85147-0115
US

IV. Provider business mailing address

483 W. SEED FARM RD. CREDENTIALING
SACATON AZ
85147-0115
US

V. Phone/Fax

Practice location:
  • Phone: 602-528-1340
  • Fax: 602-528-1296
Mailing address:
  • Phone: 602-528-1340
  • Fax: 602-528-1296

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License NumberTRIBAL
License Number StateAZ

VIII. Authorized Official

Name: MR. KAYLOR SCHEMBURGER
Title or Position: CEO
Credential:
Phone: 602-528-1200