Provider Demographics
NPI:1396022026
Name:DHHS IHS PHOENIX AREA
Entity Type:Organization
Organization Name:DHHS IHS PHOENIX AREA
Other - Org Name:CHEMEHUEVI HEALTH CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SUPERVISOR, PATIENT BUSINESS OFFC.
Authorized Official - Prefix:
Authorized Official - First Name:SKY
Authorized Official - Middle Name:RAINBOW
Authorized Official - Last Name:BLACK ELK-VOLKMANN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-384-4844
Mailing Address - Street 1:1970 PALO VERDE DRIVE
Mailing Address - Street 2:
Mailing Address - City:HAVASU LAKE
Mailing Address - State:CA
Mailing Address - Zip Code:92363-1858
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1970 PALO VERDE
Practice Address - Street 2:
Practice Address - City:HAVASU LAKE
Practice Address - State:CA
Practice Address - Zip Code:92363
Practice Address - Country:US
Practice Address - Phone:760-858-4790
Practice Address - Fax:928-669-3232
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PARKER INDIAN HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-11-09
Last Update Date:2022-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP0904XAmbulatory Health Care FacilitiesClinic/CenterPublic Health, Federal
Provider Identifiers
StateIdentifier IDID TypeIssuer
HSZ136Medicare UPIN