Provider Demographics
NPI:1740359108
Name:KAYENTA ALTERNATIVE RURAL HOSPITAL
Entity type:Organization
Organization Name:KAYENTA ALTERNATIVE RURAL HOSPITAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TERRI
Authorized Official - Middle Name:MAE
Authorized Official - Last Name:KELEWOOD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-697-5059
Mailing Address - Street 1:PO BOX 7397
Mailing Address - Street 2:HWY 98 NAVAJO ROUTE 16
Mailing Address - City:SHONTO
Mailing Address - State:AZ
Mailing Address - Zip Code:86054-7397
Mailing Address - Country:US
Mailing Address - Phone:928-672-3000
Mailing Address - Fax:
Practice Address - Street 1:HWY 98 & NAVAJO ROUTE 16
Practice Address - Street 2:
Practice Address - City:TONALEA
Practice Address - State:AZ
Practice Address - Zip Code:86044-7397
Practice Address - Country:US
Practice Address - Phone:928-672-3000
Practice Address - Fax:928-697-4030
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KAYENTA ALTERNATIVE RURAL HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-11-07
Last Update Date:2024-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ060690Medicaid
AZ060690Medicaid