Provider Demographics
| NPI: | 1003525312 |
|---|---|
| Name: | NATIVE COUNTRY HEALTHCARE SYSTEMS |
| Entity type: | Organization |
| Organization Name: | NATIVE COUNTRY HEALTHCARE SYSTEMS |
| Other - Org Name: | |
| Other - Org Type: | |
| Authorized Official - Title/Position: | PRESIDENT |
| Authorized Official - Prefix: | PROF |
| Authorized Official - First Name: | UGORJI |
| Authorized Official - Middle Name: | WILSON |
| Authorized Official - Last Name: | ONYEANI |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | RN,MD |
| Authorized Official - Phone: | 602-922-6182 |
| Mailing Address - Street 1: | 4805 W THOMAS RD |
| Mailing Address - Street 2: | |
| Mailing Address - City: | PHOENIX |
| Mailing Address - State: | AZ |
| Mailing Address - Zip Code: | 85031-4050 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 602-706-8741 |
| Mailing Address - Fax: | |
| Practice Address - Street 1: | 4805 W THOMAS RD |
| Practice Address - Street 2: | |
| Practice Address - City: | PHOENIX |
| Practice Address - State: | AZ |
| Practice Address - Zip Code: | 85031-4050 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 602-706-8741 |
| Practice Address - Fax: | |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | No |
| Parent Organization LBN: | |
| Parent Organization TIN: | |
| Enumeration Date: | 2022-11-16 |
| Last Update Date: | 2022-11-16 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 251S00000X | Agencies | Community/Behavioral Health | ||
| No | 101YA0400X | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | Group - Multi-Specialty |
| No | 251B00000X | Agencies | Case Management | ||
| No | 261QD0000X | Ambulatory Health Care Facilities | Clinic/Center | Dental | |
| No | 261QE0002X | Ambulatory Health Care Facilities | Clinic/Center | Emergency Care | |
| No | 261QE0700X | Ambulatory Health Care Facilities | Clinic/Center | End-Stage Renal Disease (ESRD) Treatment | |
| No | 261QI0500X | Ambulatory Health Care Facilities | Clinic/Center | Infusion Therapy | |
| No | 261QM0801X | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) | |
| No | 261QM0855X | Ambulatory Health Care Facilities | Clinic/Center | Adolescent and Children Mental Health | |
| No | 261QM1300X | Ambulatory Health Care Facilities | Clinic/Center | Multi-Specialty | |
| No | 261QM2800X | Ambulatory Health Care Facilities | Clinic/Center | Methadone | |
| No | 261QP2300X | Ambulatory Health Care Facilities | Clinic/Center | Primary Care | |
| No | 261QU0200X | Ambulatory Health Care Facilities | Clinic/Center | Urgent Care | |
| No | 282N00000X | Hospitals | General Acute Care Hospital | ||
| No | 3336C0002X | Suppliers | Pharmacy | Clinic Pharmacy |
