MEDICARE: WINSLOW INDIAN HEALTH CARE CENTER, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1760723753
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WINSLOW INDIAN HEALTH CARE CENTER, INC

Provider Business Mailing Address
First Line	:	500 INDIANA AVE
Second Line	:
City	:	WINSLOW
State	:	AZ
Zip	:	86047-2169
Country	:	US
Telephone Number	:	928-289-4646
Fax Number	:	928-289-6290

Provider Business Practice Location Address
First Line	:	1.5 N OF LEUPP CHAPTER HOUSE
Second Line	:
City	:	LEUPP
State	:	AZ
Zip	:	86035-9998
Country	:	US
Telephone Number	:	928-289-4646
Fax Number	:	928-289-6290

Authorized Official
Title or Position	:	CHIEF EXECUTIVE OFFICER
Name	:	MR. VIRGIL DAVIS
Credential	:	CEO
Telephone Number	:	928-289-4646

Provider Enumeration Date	:	03/15/2013
Last Update Date	:	09/26/2025

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