MEDICARE: ARCHIE HENDRICKS SR SKILLED NURSING FACILITY

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	261QR0400X	Rehabilitation Clinic/Center	TRIBAL SERVICE	AZ

General Provider Information

NPI Number	:	1962810127
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ARCHIE HENDRICKS SR SKILLED NURSING FACILITY

Provider Business Mailing Address
First Line	:	HC 1 BOX 9100
Second Line	:
City	:	SELLS
State	:	AZ
Zip	:	85634-9744
Country	:	US
Telephone Number	:	520-585-5500
Fax Number	:	520-585-5510

Provider Business Practice Location Address
First Line	:	FEDERAL ROUTE 15 MILEPOST 9
Second Line	:
City	:	SELLS
State	:	AZ
Zip	:	85634-9744
Country	:	US
Telephone Number	:	520-585-5500
Fax Number	:	520-585-5500

Authorized Official
Title or Position	:	CFO/BUSINESS OFFICE DIRECTOR
Name	:	JAMES A CHASTON
Credential	:
Telephone Number	:	520-585-5500

Provider Enumeration Date	:	07/31/2014
Last Update Date	:	10/28/2024

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