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General NPI Number Information
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NPI Number | 1083887574
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Entity Type | Organization
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Legal Business Name | COLORADO RIVER INDIAN TRIBES
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Dates
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Enumeration Date | 04/07/2008
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Last Update Date | 10/14/2022
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Provider Practice Location Address
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Address Line | 12033 AGENCY ROAD SUITE 730
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City | PARKER
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State | AZ
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Zip | 85344
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Country | US
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Telephone | 928-669-3256
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Fax | 928-669-8881
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Provider Business Mailing Address
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Address Line | 12302 KENNEDY DRIVE
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City | PARKER
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State | AZ
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Zip | 85344
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Country | US
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Telephone | 928-669-6577
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Fax | 928-669-8881
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Authorized Official
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Title or Position | DHSS EXECUTIVE DIRECTOR
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Name | ANDREA LA ROSE JOHNSON HARPER JR.
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Credential |
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Telephone | 928-669-6577
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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