Provider Demographics
NPI: | 1003525312 |
---|---|
Name: | NATIVE COUNTRY HEALTHCARE SYSTEMS |
Entity Type: | Organization |
Organization Name: | NATIVE COUNTRY HEALTHCARE SYSTEMS |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | PRESIDENT |
Authorized Official - Prefix: | PROF |
Authorized Official - First Name: | UGORJI |
Authorized Official - Middle Name: | WILSON |
Authorized Official - Last Name: | ONYEANI |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | RN,MD |
Authorized Official - Phone: | 602-922-6182 |
Mailing Address - Street 1: | 4805 W THOMAS RD |
Mailing Address - Street 2: | |
Mailing Address - City: | PHOENIX |
Mailing Address - State: | AZ |
Mailing Address - Zip Code: | 85031-4050 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 602-706-8741 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 4805 W THOMAS RD |
Practice Address - Street 2: | |
Practice Address - City: | PHOENIX |
Practice Address - State: | AZ |
Practice Address - Zip Code: | 85031-4050 |
Practice Address - Country: | US |
Practice Address - Phone: | 602-706-8741 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2022-11-16 |
Last Update Date: | 2022-11-16 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 251S00000X | Agencies | Community/Behavioral Health | ||
No | 101YA0400X | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | Group - Multi-Specialty |
No | 251B00000X | Agencies | Case Management | ||
No | 261QD0000X | Ambulatory Health Care Facilities | Clinic/Center | Dental | |
No | 261QE0002X | Ambulatory Health Care Facilities | Clinic/Center | Emergency Care | |
No | 261QE0700X | Ambulatory Health Care Facilities | Clinic/Center | End-Stage Renal Disease (ESRD) Treatment | |
No | 261QI0500X | Ambulatory Health Care Facilities | Clinic/Center | Infusion Therapy | |
No | 261QM0801X | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) | |
No | 261QM0855X | Ambulatory Health Care Facilities | Clinic/Center | Adolescent and Children Mental Health | |
No | 261QM1300X | Ambulatory Health Care Facilities | Clinic/Center | Multi-Specialty | |
No | 261QM2800X | Ambulatory Health Care Facilities | Clinic/Center | Methadone | |
No | 261QP2300X | Ambulatory Health Care Facilities | Clinic/Center | Primary Care | |
No | 261QU0200X | Ambulatory Health Care Facilities | Clinic/Center | Urgent Care | |
No | 282N00000X | Hospitals | General Acute Care Hospital | ||
No | 3336C0002X | Suppliers | Pharmacy | Clinic Pharmacy |