Healthcare Provider Details

I. General information

NPI: 1639127509
Provider Name (Legal Business Name): NH GUAM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 06/13/2025
Certification Date: 06/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BLDG 50 FARENHOLT AVENUE
AGANA HEIGHTS GU
96919
US

IV. Provider business mailing address

PSC 455 BOX 208
FPO AP
96540-0003
US

V. Phone/Fax

Practice location:
  • Phone: 671-344-9242
  • Fax: 671-344-9261
Mailing address:
  • Phone: 671-344-9242
  • Fax: 671-344-9261

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2865M2000X
TaxonomyMilitary General Acute Care Hospital
License Number
License Number State

VIII. Authorized Official

Name: JEANNETTE RIVERA
Title or Position: UBO MANAGER
Credential:
Phone: 671-344-7022