Healthcare Provider Details

I. General information

NPI: 1316571441
Provider Name (Legal Business Name): CANONCITO BAND OF NAVAJOS HEALTH CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2020
Last Update Date: 02/27/2020
Certification Date: 02/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

129 MEDICINE HORSE DR
TOHAJIILEE NM
87026-3338
US

IV. Provider business mailing address

PO BOX 3338
TOHAJIILEE NM
87026-3338
US

V. Phone/Fax

Practice location:
  • Phone: 505-908-2307
  • Fax: 505-908-2310
Mailing address:
  • Phone: 505-908-2380
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: CYNTHIA M STRZEPEK BROWNING
Title or Position: FINANCE DIRECTOR-CONTROLLER
Credential: MBA
Phone: 505-908-2380