Provider Demographics
NPI:1417128265
Name:NA'NIZHOOZHI CENTER, INC
Entity Type:Organization
Organization Name:NA'NIZHOOZHI CENTER, INC
Other - Org Name:1WINSLOW
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:LOREN
Authorized Official - Middle Name:
Authorized Official - Last Name:SEKAYUMPTEWA
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:505-722-2177
Mailing Address - Street 1:2205 BOYD AVE
Mailing Address - Street 2:
Mailing Address - City:GALLUP
Mailing Address - State:NM
Mailing Address - Zip Code:87301-7404
Mailing Address - Country:US
Mailing Address - Phone:505-722-9066
Mailing Address - Fax:505-722-9254
Practice Address - Street 1:105 COTTONWOOD AVE
Practice Address - Street 2:
Practice Address - City:WINSLOW
Practice Address - State:AZ
Practice Address - Zip Code:86047
Practice Address - Country:US
Practice Address - Phone:505-722-2177
Practice Address - Fax:505-722-9254
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NA'NIZHOOZHI CENTER, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-03-20
Last Update Date:2008-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM1831243732Medicaid