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General NPI Number Information
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NPI Number | 1134292485
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Entity Type | Organization
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Legal Business Name | LITTLE COLORADO BEHAVIORAL HEALTH CENTER INC.
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Dates
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Enumeration Date | 11/16/2006
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Last Update Date | 09/18/2024
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Provider Practice Location Address
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Address Line | 470 W CLEVELAND ST
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City | SAINT JOHNS
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State | AZ
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Zip | 85936-4501
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Country | US
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Telephone | 928-337-4301
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Fax | 928-337-2269
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Provider Business Mailing Address
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Address Line | PO BOX 579
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City | SAINT JOHNS
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State | AZ
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Zip | 85936-0579
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Country | US
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Telephone | 928-337-4301
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Fax | 928-337-2269
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Authorized Official
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Title or Position | CEO
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Name | MR. JOHN HOGEBOOM
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Credential |
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Telephone | 480-831-7566
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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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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