Healthcare Provider Details

I. General information

NPI: 1114960093
Provider Name (Legal Business Name): DHHS PHS NAIHS CROWNPOINT HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2006
Last Update Date: 10/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

JUNCTION OF HWY 371 NAVAJO RT9
CROWNPOINT NM
87313-0358
US

IV. Provider business mailing address

PO BOX 358
CROWNPOINT NM
87313-0358
US

V. Phone/Fax

Practice location:
  • Phone: 505-786-5291
  • Fax: 505-786-6440
Mailing address:
  • Phone: 505-786-5291
  • Fax: 505-786-6440

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number
License Number State

VIII. Authorized Official

Name: MR. ANSLEM ROANHORSE
Title or Position: CEO
Credential:
Phone: 505-786-5291