Provider Demographics
NPI:1366835076
Name:WINSLOW INDIAN HEALTH CARE CENTER, INC
Entity Type:Organization
Organization Name:WINSLOW INDIAN HEALTH CARE CENTER, INC
Other - Org Name:DILKON BEHAVIORAL HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SALLY
Authorized Official - Middle Name:
Authorized Official - Last Name:PETE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-289-4646
Mailing Address - Street 1:PO BOX 400
Mailing Address - Street 2:
Mailing Address - City:WINSLOW
Mailing Address - State:AZ
Mailing Address - Zip Code:86047-0400
Mailing Address - Country:US
Mailing Address - Phone:928-289-6297
Mailing Address - Fax:928-289-6290
Practice Address - Street 1:SWC NAVAJO ROUTE 15 & 60
Practice Address - Street 2:
Practice Address - City:DILKON
Practice Address - State:AZ
Practice Address - Zip Code:86047
Practice Address - Country:US
Practice Address - Phone:928-289-4646
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-05
Last Update Date:2023-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZTEZ085Medicare PIN