Healthcare Provider Details

I. General information

NPI: 1285938456
Provider Name (Legal Business Name): GILA RIVER HEALTH CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2011
Last Update Date: 01/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

483 W. SEED FARM
SACATON AZ
85147-0000
US

IV. Provider business mailing address

PO BOX 38
SACATON AZ
85147-0001
US

V. Phone/Fax

Practice location:
  • Phone: 602-528-7100
  • Fax: 602-528-1314
Mailing address:
  • Phone: 602-528-7100
  • Fax: 602-528-1314

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NR1301X
TaxonomyRural Acute Care Hospital
License Number101YP2500X
License Number StateAZ

VIII. Authorized Official

Name: MR. STEVEN A. GREEN
Title or Position: EXEC. DIRECTOR
Credential:
Phone: 602-528-7100