Provider Demographics
NPI:1346377926
Name:KAYENTA ALTERNATIVE RURAL HOSPITAL
Entity Type:Organization
Organization Name:KAYENTA ALTERNATIVE RURAL HOSPITAL
Other - Org Name:INSCRIPTION HOUSE HEALTH CENTER PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BUSINESS OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TERRI
Authorized Official - Middle Name:MAE
Authorized Official - Last Name:KELEWOOD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-697-5059
Mailing Address - Street 1:KAYENTA INDIAN HEALTH CTR
Mailing Address - Street 2:PO BOX 31001-0655
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91110-0655
Mailing Address - Country:US
Mailing Address - Phone:928-672-3029
Mailing Address - Fax:
Practice Address - Street 1:HWY 98 AND NAVAJO RT 16
Practice Address - Street 2:
Practice Address - City:SHONTO
Practice Address - State:AZ
Practice Address - Zip Code:86054
Practice Address - Country:US
Practice Address - Phone:928-672-3029
Practice Address - Fax:928-672-3005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-28
Last Update Date:2023-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332800000XSuppliersIndian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ060690Medicaid
1990677OtherPK