Healthcare Provider Details

I. General information

NPI: 1821273475
Provider Name (Legal Business Name): TOHONO O'ODHAM NATION- DHS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/02/2008
Last Update Date: 12/07/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ST. RTE.86-MULTIHEALTH COMPLEX TRANSPORTATION SERVICES
SELLS AZ
85634
US

IV. Provider business mailing address

PO BOX 810
SELLS AZ
85634-0810
US

V. Phone/Fax

Practice location:
  • Phone: 520-383-6050
  • Fax: 520-383-6065
Mailing address:
  • Phone: 520-383-6050
  • Fax: 520-383-6065

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: MR. EDWARD D MANUEL
Title or Position: CHAIRMAN
Credential:
Phone: 520-383-2028