Provider Demographics
NPI:1558896746
Name:SELAH CARE, INC
Entity Type:Organization
Organization Name:SELAH CARE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:HARRISON
Authorized Official - Middle Name:
Authorized Official - Last Name:HATFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-708-9960
Mailing Address - Street 1:240 S MONTEZUMA ST
Mailing Address - Street 2:SUITE 206
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86303-4712
Mailing Address - Country:US
Mailing Address - Phone:928-708-9960
Mailing Address - Fax:
Practice Address - Street 1:240 S MONTEZUMA ST
Practice Address - Street 2:SUITE 206
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86303-4712
Practice Address - Country:US
Practice Address - Phone:928-708-9960
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-25
Last Update Date:2017-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZBL-01985305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization