Provider Demographics
NPI:1073755013
Name:GILA RIVER INDIAN COMMUNITY DEPARTMENT OF HUMAN SERVICES
Entity Type:Organization
Organization Name:GILA RIVER INDIAN COMMUNITY DEPARTMENT OF HUMAN SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:GLENN
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:CUMMINGS
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LISAC, LPC
Authorized Official - Phone:520-796-3802
Mailing Address - Street 1:PO BOX 602
Mailing Address - Street 2:
Mailing Address - City:LAVEEN
Mailing Address - State:AZ
Mailing Address - Zip Code:85339-0602
Mailing Address - Country:US
Mailing Address - Phone:520-796-3860
Mailing Address - Fax:520-796-3801
Practice Address - Street 1:3850 N. 16 STREET
Practice Address - Street 2:
Practice Address - City:LAVEEN
Practice Address - State:AZ
Practice Address - Zip Code:85339
Practice Address - Country:US
Practice Address - Phone:520-796-3860
Practice Address - Fax:520-796-3801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-06
Last Update Date:2009-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ074165OtherARIZONA HEALTH CARE COST CONTAINMENT SYSTEM
AZ411673OtherARIZONA HEALTH CARE COST CONTAINMENT SYSTEM