Provider Demographics
NPI:1073923066
Name:DOUGLAS COMMUNITY HOSPITAL, INC.
Entity Type:Organization
Organization Name:DOUGLAS COMMUNITY HOSPITAL, INC.
Other - Org Name:COCHISE REGIONAL HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:ROBERTA
Authorized Official - Middle Name:
Authorized Official - Last Name:BERRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-805-5943
Mailing Address - Street 1:2174 W OAK AVE
Mailing Address - Street 2:
Mailing Address - City:DOUGLAS
Mailing Address - State:AZ
Mailing Address - Zip Code:85607-6003
Mailing Address - Country:US
Mailing Address - Phone:520-364-7931
Mailing Address - Fax:
Practice Address - Street 1:2174 W OAK AVE
Practice Address - Street 2:
Practice Address - City:DOUGLAS
Practice Address - State:AZ
Practice Address - Zip Code:85607-6003
Practice Address - Country:US
Practice Address - Phone:520-364-7931
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-30
Last Update Date:2014-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZH6226282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital