Provider Demographics
NPI:1457489890
Name:CHIRICAHUA COMMUNITY HEALTH CENTERS, INC
Entity Type:Organization
Organization Name:CHIRICAHUA COMMUNITY HEALTH CENTERS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:P
Authorized Official - Last Name:MELK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-364-6852
Mailing Address - Street 1:1205 F AVENUE
Mailing Address - Street 2:
Mailing Address - City:DOUGLAS
Mailing Address - State:AZ
Mailing Address - Zip Code:85607
Mailing Address - Country:US
Mailing Address - Phone:520-364-6852
Mailing Address - Fax:520-364-4261
Practice Address - Street 1:10566 N HIGHWAY 191
Practice Address - Street 2:
Practice Address - City:ELFRIDA
Practice Address - State:AZ
Practice Address - Zip Code:85610-9021
Practice Address - Country:US
Practice Address - Phone:520-642-2222
Practice Address - Fax:520-364-4261
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-28
Last Update Date:2021-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZOTC0924261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)Group - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ941042Medicaid
AZ941042Medicaid