Healthcare Provider Details

I. General information

NPI: 1245663996
Provider Name (Legal Business Name): SUNSET COMMUNITY HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2013
Last Update Date: 06/05/2024
Certification Date: 06/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2060 W 24TH ST
YUMA AZ
85364-6123
US

IV. Provider business mailing address

2060 W 24TH ST
YUMA AZ
85364-6123
US

V. Phone/Fax

Practice location:
  • Phone: 928-819-8999
  • Fax: 928-539-5579
Mailing address:
  • Phone: 928-819-8999
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberOTC5045
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: MRS. ADA E CARLOS
Title or Position: ACCOUNTS RECEIVABLE SUPERVISOR
Credential:
Phone: 928-329-5447