Healthcare Provider Details

I. General information

NPI: 1306777081
Provider Name (Legal Business Name): GILA VALLEY PREMIER CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/29/2026
Last Update Date: 05/29/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

326 S REAY LN UNIT 102
THATCHER AZ
85552-0854
US

IV. Provider business mailing address

2942 N 24TH ST
PHOENIX AZ
85016-7844
US

V. Phone/Fax

Practice location:
  • Phone: 928-459-7328
  • Fax:
Mailing address:
  • Phone: 480-225-8629
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: CHRISTOPHER BROGAN
Title or Position: OWNER/NURSE PRACTITIONER
Credential: NP
Phone: 480-225-8629