Provider Demographics
NPI:1730310046
Name:GREENLEE COUNTY
Entity Type:Organization
Organization Name:GREENLEE COUNTY
Other - Org Name:GREENLEE HEALTH AND COUNTY SERVICES
Other - Org Type:Other Name
Authorized Official - Title/Position:DEPUTY DIRECTOR HEALTH AND COUNTY
Authorized Official - Prefix:MR
Authorized Official - First Name:DARREN
Authorized Official - Middle Name:C
Authorized Official - Last Name:SANDERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-865-2601
Mailing Address - Street 1:PO BOX 936
Mailing Address - Street 2:253 5TH STREET
Mailing Address - City:CLIFTON
Mailing Address - State:AZ
Mailing Address - Zip Code:85533-0936
Mailing Address - Country:US
Mailing Address - Phone:928-865-2601
Mailing Address - Fax:928-865-1929
Practice Address - Street 1:253 5TH STREET
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:AZ
Practice Address - Zip Code:85533-0936
Practice Address - Country:US
Practice Address - Phone:928-865-2601
Practice Address - Fax:928-865-1929
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-04
Last Update Date:2009-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZOTC0267261QA0005X, 261QP0905X, 261QP2400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP0905XAmbulatory Health Care FacilitiesClinic/CenterPublic Health, State or Local
No261QA0005XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Family Planning Facility
No261QP2400XAmbulatory Health Care FacilitiesClinic/CenterPrison Health