Provider Demographics
NPI:1609328194
Name:AK-CHIN HEALTH & HUMAN SERVICES
Entity Type:Organization
Organization Name:AK-CHIN HEALTH & HUMAN SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLIDAY
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:520-568-1090
Mailing Address - Street 1:48227 W FARRELL RD
Mailing Address - Street 2:
Mailing Address - City:MARICOPA
Mailing Address - State:AZ
Mailing Address - Zip Code:85139-3806
Mailing Address - Country:US
Mailing Address - Phone:520-568-1090
Mailing Address - Fax:520-568-1096
Practice Address - Street 1:48227 W FARRELL RD
Practice Address - Street 2:
Practice Address - City:MARICOPA
Practice Address - State:AZ
Practice Address - Zip Code:85139-3806
Practice Address - Country:US
Practice Address - Phone:520-568-1090
Practice Address - Fax:520-568-1096
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AK-CHIN INDIAN COMMUNITY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-10-31
Last Update Date:2016-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health