Healthcare Provider Details

I. General information

NPI: 1649061839
Provider Name (Legal Business Name): TOHONO O'ODHAM NURSING CARE AUTHORITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2025
Last Update Date: 05/15/2025
Certification Date: 05/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

FEDERAL ROUTE 15 MILEPOST 9
SELLS AZ
85634
US

IV. Provider business mailing address

HC 1 BOX 9100
SELLS AZ
85634-9744
US

V. Phone/Fax

Practice location:
  • Phone: 520-585-5500
  • Fax: 520-585-5510
Mailing address:
  • Phone: 520-585-5500
  • Fax: 520-585-5510

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: ROSS WILKOFF
Title or Position: ADMINISTRATOR
Credential: LNHA
Phone: 520-585-5500