Provider Demographics
NPI:1598897290
Name:CIBECUE HEALTH CENTER
Entity Type:Organization
Organization Name:CIBECUE HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FACILITY DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BETTINA
Authorized Official - Middle Name:
Authorized Official - Last Name:BEGAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-332-2560
Mailing Address - Street 1:NORTH CROMWELL RD
Mailing Address - Street 2:
Mailing Address - City:CIBECUE
Mailing Address - State:AZ
Mailing Address - Zip Code:85911
Mailing Address - Country:US
Mailing Address - Phone:928-332-2560
Mailing Address - Fax:
Practice Address - Street 1:NORTH CROMWELL RD
Practice Address - Street 2:
Practice Address - City:CIBECUE
Practice Address - State:AZ
Practice Address - Zip Code:85911
Practice Address - Country:US
Practice Address - Phone:928-332-2560
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ020561Medicaid
AZ020561Medicaid
AZ030113Medicare Oscar/Certification