Healthcare Provider Details

I. General information

NPI: 1023683315
Provider Name (Legal Business Name): COMMUNITY HOSPITAL ASSOCIATION, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2021
Last Update Date: 05/20/2021
Certification Date: 05/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

519 ROSE LN STE A
WICKENBURG AZ
85390-1448
US

IV. Provider business mailing address

523 ROSE LN
WICKENBURG AZ
85390-1448
US

V. Phone/Fax

Practice location:
  • Phone: 928-684-5421
  • Fax:
Mailing address:
  • Phone: 928-668-1845
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JACKIE LUNDBLAD
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 928-684-5421