Healthcare Provider Details

I. General information

NPI: 1265719918
Provider Name (Legal Business Name): DHHS PHS IHS PHOENIX AREA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2011
Last Update Date: 02/15/2023
Certification Date: 02/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 PICACHO ROAD
WINTERHAVEN CA
92283
US

IV. Provider business mailing address

PO BOX 1368
YUMA AZ
85366-2361
US

V. Phone/Fax

Practice location:
  • Phone: 760-572-4100
  • Fax: 760-572-2133
Mailing address:
  • Phone: 760-572-4100
  • Fax: 760-572-4183

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: TRICIA CHAMBERLAIN
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 760-572-4100