Healthcare Provider Details

I. General information

NPI: 1598785081
Provider Name (Legal Business Name): CANYON HEALTH CARE SERVICES,INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

932 N CAMINO SECO
TUCSON AZ
85710-1708
US

IV. Provider business mailing address

932 N CAMINO SECO
TUCSON AZ
85710-1708
US

V. Phone/Fax

Practice location:
  • Phone: 520-721-1925
  • Fax: 520-721-1925
Mailing address:
  • Phone: 520-721-1925
  • Fax: 520-721-1925

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WA2000X
TaxonomyAdministrator Registered Nurse
License Number
License Number StateAZ

VIII. Authorized Official

Name: MR. EMMANUEL I UWAJEH
Title or Position: PRESIDENT
Credential:
Phone: 520-245-3056