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General NPI Number Information
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NPI Number | 1841703253
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Entity Type | Organization
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Legal Business Name | TRI-STATE COMMUNITY HEALTHCARE CENTER
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Dates
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Enumeration Date | 11/07/2017
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Last Update Date | 11/07/2017
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Provider Practice Location Address
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Address Line | 8700 S HIGHWAY 95
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City | MOHAVE VALLEY
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State | AZ
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Zip | 86440-8519
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Country | US
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Telephone | 928-768-7113
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Fax |
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Provider Business Mailing Address
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Address Line | 8700 S HIGHWAY 95
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City | MOHAVE VALLEY
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State | AZ
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Zip | 86440-8519
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | ARAM MANOUKIAN
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Credential | CEO
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Telephone | 760-326-0222
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QF0400X
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Taxonomy Name | Federally Qualified Health Center (FQHC)
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License Number |
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License Number State |
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