Provider Demographics
NPI:1811605942
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:847-766-9779
Mailing Address - Street 1:1241 E BROADWAY RD STE 14
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85204-2254
Mailing Address - Country:US
Mailing Address - Phone:847-766-9779
Mailing Address - Fax:
Practice Address - Street 1:1241 E BROADWAY RD STE 14
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85204-2254
Practice Address - Country:US
Practice Address - Phone:847-766-9779
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NATIVE COUNTRY HEALTHCARE SYSTEMS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-11-08
Last Update Date:2022-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No310500000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Mental Illness
No323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility
No3245S0500XResidential Treatment FacilitiesSubstance Abuse Rehabilitation FacilitySubstance Abuse Treatment, Children
No276400000XHospital UnitsRehabilitation, Substance Use Disorder Unit
No3336C0002XSuppliersPharmacyClinic Pharmacy
No3336M0002XSuppliersPharmacyMail Order Pharmacy
No3336M0003XSuppliersPharmacyManaged Care Organization Pharmacy
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)