Healthcare Provider Details

I. General information

NPI: 1861556078
Provider Name (Legal Business Name): WHITE MOUNTAIN MEALS ON WHEELS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/21/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 E MCNEIL
SHOW LOW AZ
85901-5952
US

IV. Provider business mailing address

301 E MCNEIL
SHOW LOW AZ
85901-5952
US

V. Phone/Fax

Practice location:
  • Phone: 480-814-9046
  • Fax:
Mailing address:
  • Phone: 480-814-9046
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number State

VIII. Authorized Official

Name: JOEL PREMSELAAR
Title or Position: CHAIRMAN
Credential:
Phone: 480-814-9046