Healthcare Provider Details

I. General information

NPI: 1548763253
Provider Name (Legal Business Name): DHHS PHS NAIHS CHINLE COMPREHENSIVE HEALTH CARE FACILITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/09/2018
Last Update Date: 03/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

NAVAJO ROUTE 64 & 12
TSAILE AZ
86556
US

IV. Provider business mailing address

PO BOX C021
TSAILE AZ
86556-5048
US

V. Phone/Fax

Practice location:
  • Phone: 928-724-3600
  • Fax: 928-724-3605
Mailing address:
  • Phone: 928-724-3600
  • Fax: 928-724-3605

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: PATRICK J YAZZIE
Title or Position: BUSINESS OFFICE MANAGER
Credential:
Phone: 928-674-7030