Provider Demographics
NPI:1750634465
Name:TCRHCC MOBILE HEALTHCARE VAN SYSTEM
Entity Type:Organization
Organization Name:TCRHCC MOBILE HEALTHCARE VAN SYSTEM
Other - Org Name:LECHEE CHAPTER HOUSE
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:T
Authorized Official - Last Name:ENGELKEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-283-2501
Mailing Address - Street 1:PO BOX 600
Mailing Address - Street 2:BASE OF OPERATIONS: 167 NORTH MAIN STREET
Mailing Address - City:TUBA CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86045-0600
Mailing Address - Country:US
Mailing Address - Phone:928-283-2781
Mailing Address - Fax:928-283-2677
Practice Address - Street 1:3 MI S OF PAGE ON NR-20 COPPERMINE RD
Practice Address - Street 2:KAIBETO CHAPTER HOUSE
Practice Address - City:LECHEE
Practice Address - State:AZ
Practice Address - Zip Code:86040
Practice Address - Country:US
Practice Address - Phone:928-283-2501
Practice Address - Fax:928-283-2677
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TUBA CITY REGIONAL HEALTH CARE CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-10-18
Last Update Date:2012-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center