Provider Demographics
NPI:1740333160
Name:US DEPT. HEALTH & HUMAN SERVICES - USPHS INDIAN HEALTH SERVICES
Entity type:Organization
Organization Name:US DEPT. HEALTH & HUMAN SERVICES - USPHS INDIAN HEALTH SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:JANAY
Authorized Official - Middle Name:
Authorized Official - Last Name:CEDARFACE
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:505-552-5500
Mailing Address - Street 1:P.O. BOX 219
Mailing Address - Street 2:
Mailing Address - City:SAN FIDEL
Mailing Address - State:NM
Mailing Address - Zip Code:87049
Mailing Address - Country:US
Mailing Address - Phone:505-552-5500
Mailing Address - Fax:505-552-5530
Practice Address - Street 1:20 MOCKINGBIRD DR.
Practice Address - Street 2:
Practice Address - City:SAN FIDEL
Practice Address - State:NM
Practice Address - Zip Code:87049
Practice Address - Country:US
Practice Address - Phone:505-552-5500
Practice Address - Fax:505-552-5530
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-19
Last Update Date:2016-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ642985Medicaid
NM95715Medicaid
CO87924277Medicaid