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General NPI Number Information
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NPI Number | 1740333160
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Entity Type | Organization
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Legal Business Name | US DEPT. HEALTH & HUMAN SERVICES - USPHS INDIAN HEALTH SERVICES
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Dates
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Enumeration Date | 01/19/2007
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Last Update Date | 05/24/2016
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Provider Practice Location Address
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Address Line | 20 MOCKINGBIRD DR.
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City | SAN FIDEL
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State | NM
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Zip | 87049
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Country | US
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Telephone | 505-552-5500
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Fax | 505-552-5530
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Provider Business Mailing Address
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Address Line | P.O. BOX 219
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City | SAN FIDEL
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State | NM
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Zip | 87049
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Country | US
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Telephone | 505-552-5500
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Fax | 505-552-5530
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | JANAY CEDARFACE
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Credential | MBA
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Telephone | 505-552-5500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number |
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License Number State | NM
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