Healthcare Provider Details

I. General information

NPI: 1417153685
Provider Name (Legal Business Name): TOHONO O'ODHAM NATION - DIVISION OF BEHAVIORAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HIGHWAY 86 - SELLS BUSINESS LOOP HIGHWAY 86 - SELLS BUSINESS LOOP
SELLS AZ
85634-0810
US

IV. Provider business mailing address

PO BOX 810 HEALTH & HUMAN SERVICE COMPLEX - HIGHWAY 86
SELLS AZ
85634-0810
US

V. Phone/Fax

Practice location:
  • Phone: 520-383-6165
  • Fax: 520-383-5433
Mailing address:
  • Phone: 520-383-6165
  • Fax: 520-383-5433

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number StateAZ

VIII. Authorized Official

Name: MR. NED NORRIS JR.
Title or Position: CHAIRMAN
Credential:
Phone: 520-383-2028