Provider Demographics
NPI:1073711693
Name:NAVAJO REGIONAL BEHAVIORAL HEALTH CENTER - ADOLESCENT RESIDENTIAL
Entity Type:Organization
Organization Name:NAVAJO REGIONAL BEHAVIORAL HEALTH CENTER - ADOLESCENT RESIDENTIAL
Other - Org Name:NAVAJO NATION SHIPROCK TREATMENT CENTER ADOLESCENT UNIT
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:BEHAVIORAL HEALTH DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SIDNEY
Authorized Official - Middle Name:
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:PSY D, LPC
Authorized Official - Phone:505-368-1438
Mailing Address - Street 1:PO BOX 1830
Mailing Address - Street 2:
Mailing Address - City:SHIPROCK
Mailing Address - State:NM
Mailing Address - Zip Code:87420-1830
Mailing Address - Country:US
Mailing Address - Phone:505-368-1050
Mailing Address - Fax:505-368-1467
Practice Address - Street 1:PINON & COTTONWOOD DR BUILDING #2301
Practice Address - Street 2:
Practice Address - City:SHIPROCK
Practice Address - State:NM
Practice Address - Zip Code:87402
Practice Address - Country:US
Practice Address - Phone:505-368-1438
Practice Address - Fax:505-368-1452
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-05
Last Update Date:2022-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3245S0500XResidential Treatment FacilitiesSubstance Abuse Rehabilitation FacilitySubstance Abuse Treatment, Children