Healthcare Provider Details

I. General information

NPI: 1295992345
Provider Name (Legal Business Name): NORTHERN COCHISE COMMUNITY HOSPITAL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2008
Last Update Date: 05/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 W REX ALLEN DR
WILLCOX AZ
85643-1009
US

IV. Provider business mailing address

901 W REX ALLEN DR
WILLCOX AZ
85643-1009
US

V. Phone/Fax

Practice location:
  • Phone: 520-384-3541
  • Fax:
Mailing address:
  • Phone: 520-384-3541
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License NumberNCI-301
License Number StateAZ

VIII. Authorized Official

Name: MRS. JULIE A HILTON
Title or Position: ACTING ADMINISTRATOR AND CNO
Credential:
Phone: 520-384-3541