Provider Demographics
NPI:1083887574
Name:COLORADO RIVER INDIAN TRIBES
Entity Type:Organization
Organization Name:COLORADO RIVER INDIAN TRIBES
Other - Org Name:CRIT BEHAVIORAL HEALTH SERVICES
Other - Org Type:Other Name
Authorized Official - Title/Position:DHSS EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:LA ROSE
Authorized Official - Last Name:JOHNSON HARPER
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:928-669-6577
Mailing Address - Street 1:12302 KENNEDY DRIVE
Mailing Address - Street 2:
Mailing Address - City:PARKER
Mailing Address - State:AZ
Mailing Address - Zip Code:85344
Mailing Address - Country:US
Mailing Address - Phone:928-669-6577
Mailing Address - Fax:928-669-8881
Practice Address - Street 1:12033 AGENCY ROAD
Practice Address - Street 2:SUITE 730
Practice Address - City:PARKER
Practice Address - State:AZ
Practice Address - Zip Code:85344
Practice Address - Country:US
Practice Address - Phone:928-669-3256
Practice Address - Fax:928-669-8881
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-07
Last Update Date:2022-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ629868Medicaid