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General NPI Number Information
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NPI Number | 1295897379
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Entity Type | Organization
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Legal Business Name | YAVAPAI COUNTY COMMUNITY HEALTH SERVICES
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Dates
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Enumeration Date | 12/14/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1090 COMMERCE DR
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City | PRESCOTT
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State | AZ
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Zip | 86305-3700
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Country | US
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Telephone | 928-771-3538
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Fax | 928-771-3369
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Provider Business Mailing Address
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Address Line | 1090 COMMERCE DR
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City | PRESCOTT
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State | AZ
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Zip | 86305-3700
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Country | US
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Telephone | 928-771-3538
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Fax | 928-771-3369
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Authorized Official
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Title or Position | DIRECTOR
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Name | MR. ROBERT RESENDES
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Credential |
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Telephone | 928-442-5966
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QC1500X
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Taxonomy Name | Community Health Clinic/Center
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License Number | OTC3512
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License Number State | AZ
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