Provider Demographics
NPI:1376664193
Name:COMMUNITY HOSPITAL ASSOCIATION, INC., DBA WICKENBURG COMMUNITY HOSPITA
Entity Type:Organization
Organization Name:COMMUNITY HOSPITAL ASSOCIATION, INC., DBA WICKENBURG COMMUNITY HOSPITA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DALE
Authorized Official - Middle Name:A
Authorized Official - Last Name:DECKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-684-5421
Mailing Address - Street 1:520 ROSE LN
Mailing Address - Street 2:
Mailing Address - City:WICKENBURG
Mailing Address - State:AZ
Mailing Address - Zip Code:85390-1447
Mailing Address - Country:US
Mailing Address - Phone:928-684-5421
Mailing Address - Fax:928-684-5499
Practice Address - Street 1:520 ROSE LN
Practice Address - Street 2:
Practice Address - City:WICKENBURG
Practice Address - State:AZ
Practice Address - Zip Code:85390-1447
Practice Address - Country:US
Practice Address - Phone:928-684-5421
Practice Address - Fax:928-684-5499
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3488282NR1301X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NR1301XHospitalsGeneral Acute Care HospitalRural