Provider Demographics
NPI:1366851842
Name:WHITERIVER SERVICE UNIT
Entity Type:Organization
Organization Name:WHITERIVER SERVICE UNIT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIETITIAN
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:SAMS
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:928-338-3664
Mailing Address - Street 1:PO BOX 860
Mailing Address - Street 2:
Mailing Address - City:WHITERIVER
Mailing Address - State:AZ
Mailing Address - Zip Code:85941
Mailing Address - Country:US
Mailing Address - Phone:928-338-4911
Mailing Address - Fax:
Practice Address - Street 1:200 WEST HOSPITAL DRIVE
Practice Address - Street 2:
Practice Address - City:WHITERIVER
Practice Address - State:AZ
Practice Address - Zip Code:85941
Practice Address - Country:US
Practice Address - Phone:928-338-4911
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-08
Last Update Date:2016-11-02
Deactivation Date:2015-06-11
Deactivation Code:
Reactivation Date:2016-09-12
Provider Licenses
StateLicense IDTaxonomies
OK86008901284300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes284300000XHospitalsSpecial Hospital