Provider Demographics
NPI:1538290119
Name:RAINBOW TREATMENT CENTER WHITE MOUNTAIN APACHE TRIBE
Entity Type:Organization
Organization Name:RAINBOW TREATMENT CENTER WHITE MOUNTAIN APACHE TRIBE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BLL
Authorized Official - Middle Name:
Authorized Official - Last Name:ARNETT
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:928-338-4858
Mailing Address - Street 1:302 WEST PONDERSOSA
Mailing Address - Street 2:
Mailing Address - City:WHITERIVER
Mailing Address - State:AZ
Mailing Address - Zip Code:85941-1790
Mailing Address - Country:US
Mailing Address - Phone:928-338-4858
Mailing Address - Fax:928-338-4100
Practice Address - Street 1:302 WEST PONDERSOSA
Practice Address - Street 2:
Practice Address - City:WHITERIVER
Practice Address - State:AZ
Practice Address - Zip Code:85941-1790
Practice Address - Country:US
Practice Address - Phone:928-338-4858
Practice Address - Fax:928-338-4100
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ541484261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ541484Medicaid