Provider Demographics
NPI:1821586686
Name:SAN CARLOS APACHE TRIBE
Entity Type:Organization
Organization Name:SAN CARLOS APACHE TRIBE
Other - Org Name:SAN CARLOS SOCIAL SERVICES
Other - Org Type:Other Name
Authorized Official - Title/Position:ACCOUNTANT MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:RON
Authorized Official - Middle Name:
Authorized Official - Last Name:RITTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-475-2620
Mailing Address - Street 1:PO BOX 0
Mailing Address - Street 2:
Mailing Address - City:SAN CARLOS
Mailing Address - State:AZ
Mailing Address - Zip Code:85550
Mailing Address - Country:US
Mailing Address - Phone:928-475-2620
Mailing Address - Fax:928-475-2417
Practice Address - Street 1:SAN CARLOS SOCIAL SERVICES
Practice Address - Street 2:7 SAN CARLOS AVENUE
Practice Address - City:SAN CARLOS
Practice Address - State:AZ
Practice Address - Zip Code:85550
Practice Address - Country:US
Practice Address - Phone:928-475-2313
Practice Address - Fax:928-475-2342
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SAN CARLOS APACHE TRIBE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-04-27
Last Update Date:2018-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health