Provider Demographics
NPI:1548763253
Name:DHHS PHS NAIHS CHINLE COMPREHENSIVE HEALTH CARE FACILITY
Entity Type:Organization
Organization Name:DHHS PHS NAIHS CHINLE COMPREHENSIVE HEALTH CARE FACILITY
Other - Org Name:TSAILE HEALTH CENTER BEHAVIORAL HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BUSINESS OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:J
Authorized Official - Last Name:YAZZIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-674-7030
Mailing Address - Street 1:PO BOX C021
Mailing Address - Street 2:
Mailing Address - City:TSAILE
Mailing Address - State:AZ
Mailing Address - Zip Code:86556-5048
Mailing Address - Country:US
Mailing Address - Phone:928-724-3600
Mailing Address - Fax:928-724-3605
Practice Address - Street 1:NAVAJO ROUTE 64 & 12
Practice Address - Street 2:
Practice Address - City:TSAILE
Practice Address - State:AZ
Practice Address - Zip Code:86556
Practice Address - Country:US
Practice Address - Phone:928-724-3600
Practice Address - Fax:928-724-3605
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DHHS PHS NAIHS CHINLE COMPREHENSIVE HEALTH CARE FACILITY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-03-09
Last Update Date:2018-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ061119Medicaid