Provider Demographics
NPI:1649531377
Name:PEACH SPRINGS HEALTH CENTER
Entity type:Organization
Organization Name:PEACH SPRINGS HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HEALTH CENTER DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ROSEMARY
Authorized Official - Middle Name:
Authorized Official - Last Name:SULLIVAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-769-4369
Mailing Address - Street 1:3350 HARRISON ST
Mailing Address - Street 2:H157
Mailing Address - City:KINGMAN
Mailing Address - State:AZ
Mailing Address - Zip Code:86409-0700
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:943 HUALAPAI WAY
Practice Address - Street 2:
Practice Address - City:PEACH SPRINGS
Practice Address - State:AZ
Practice Address - Zip Code:86434-0190
Practice Address - Country:US
Practice Address - Phone:928-769-2906
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DHHS INDIAN HEALTH SERVICE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-05-29
Last Update Date:2012-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory