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General NPI Number Information
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NPI Number | 1487438388
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Entity Type | Organization
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Legal Business Name | COMMUNITY HEALTH CENTER MOBILE HEALTH PROGRAM 2
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Dates
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Enumeration Date | 08/22/2023
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Last Update Date | 08/22/2023
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Provider Practice Location Address
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Address Line | BASE OF OPERATIONS 167 N MAIN STREET SERVICE AREA WESTERN NAVAJO AGENCY W IN AZ
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City | TUBA CITY
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State | AZ
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Zip | 86045
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Country | US
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Telephone | 928-283-2781
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Fax | 928-283-2677
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Provider Business Mailing Address
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Address Line | 167 N MAIN STREET PO BOX 600
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City | TUBA CITY
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State | AZ
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Zip | 86045
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Country | US
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Telephone | 928-283-2781
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Fax | 928-283-2677
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | JOETTE WALTERS
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Credential |
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Telephone | 928-283-2501
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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