Healthcare Provider Details

I. General information

NPI: 1225364615
Provider Name (Legal Business Name): CANYON HEALTHCARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2009
Last Update Date: 10/08/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

165 W SOUTH ST SUITE 208
HERNANDO MS
38632-2265
US

IV. Provider business mailing address

165 W SOUTH ST SUITE 208
HERNANDO MS
38632-2265
US

V. Phone/Fax

Practice location:
  • Phone: 844-241-1444
  • Fax: 888-891-3929
Mailing address:
  • Phone: 844-241-1444
  • Fax: 888-891-3929

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: MR. CHRIS HENRY
Title or Position: MANAGING MEMBER
Credential:
Phone: 844-241-1444