Provider Demographics
NPI:1619001849
Name:RAMAH NAVAJO SCHOOL BOARD, INC
Entity Type:Organization
Organization Name:RAMAH NAVAJO SCHOOL BOARD, INC
Other - Org Name:PINE HILL HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF HEALTH ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:BECKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-775-3271
Mailing Address - Street 1:PO BOX 310
Mailing Address - Street 2:
Mailing Address - City:PINE HILL
Mailing Address - State:NM
Mailing Address - Zip Code:87357-0310
Mailing Address - Country:US
Mailing Address - Phone:505-775-3271
Mailing Address - Fax:505-775-3233
Practice Address - Street 1:12 BIA 120
Practice Address - Street 2:PO BOX 310
Practice Address - City:PINE HILL
Practice Address - State:NM
Practice Address - Zip Code:87357-0310
Practice Address - Country:US
Practice Address - Phone:505-775-3271
Practice Address - Fax:505-775-3233
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-16
Last Update Date:2017-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM261QF0400X, 3416L0300X
332800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
No332800000XSuppliersIndian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
No3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM00055587Medicaid
NMR0829Medicaid
NM321845Medicare Oscar/Certification
NMR0829Medicaid
NMR0829Medicaid