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General NPI Number Information
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NPI Number | 1700060878
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Entity Type | Organization
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Legal Business Name | GILA RIVER INDIAN COMMUNITY DEPARTMENT OF HUMAN SERVICES
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Dates
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Enumeration Date | 12/24/2007
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Last Update Date | 12/24/2007
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Provider Practice Location Address
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Address Line | 315 W. CASA BLANCA RD
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City | SACATON
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State | AZ
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Zip | 85247-2171
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Country | US
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Telephone | 520-562-3356
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2171
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City | SACATON
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State | AZ
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Zip | 85247-2171
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Country | US
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Telephone | 520-562-3356
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Fax |
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Authorized Official
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Title or Position | ACTING DIRECTOR
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Name | MR. GLENN THOMAS CUMMINGS
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Credential | M.A.
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Telephone | 520-562-3356
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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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