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General NPI Number Information
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NPI Number | 1902471303
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Entity Type | Organization
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Legal Business Name | CANYONLANDS COMMUNITY HEALTH CARE
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Dates
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Enumeration Date | 05/26/2021
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Last Update Date | 05/26/2021
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Provider Practice Location Address
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Address Line | 210 N SANDHILL BLVD
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City | MESQUITE
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State | NV
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Zip | 89027-4789
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Country | US
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Telephone | 702-602-0556
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1625
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City | PAGE
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State | AZ
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Zip | 86040-1625
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Country | US
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Telephone | 928-645-9675
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Fax |
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Authorized Official
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Title or Position | DIRECTOR OF OPERATIONS
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Name | MARI A REED
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Credential |
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Telephone | 928-645-9675
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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