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General NPI Number Information
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NPI Number | 1003174715
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Entity Type | Organization
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Legal Business Name | MT GRAHAM REGIONAL MEDICAL CENTER INC
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Dates
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Enumeration Date | 05/01/2012
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Last Update Date | 05/03/2012
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Provider Practice Location Address
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Address Line | 1600 S 20TH AVE BLDG E
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City | SAFFORD
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State | AZ
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Zip | 85546-4011
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Country | US
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Telephone | 928-428-5668
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Fax | 928-348-3868
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Provider Business Mailing Address
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Address Line | 1600 S 20TH AVE BLDG E
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City | SAFFORD
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State | AZ
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Zip | 85546-4011
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Country | US
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Telephone | 928-348-5668
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Fax | 928-348-3868
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MRS. JILL DENICE HEINRICH
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Credential | RN,BSN
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Telephone | 928-428-5668
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | HHA-210
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License Number State | AZ
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