National Provider Identifier Database

DHEW IND HLTH SV HLTH SVS MNTL HLTH ADM
Public Health or Welfare


Contact Information

DHEW IND HLTH SV HLTH SVS & MNTL HLTH ADM
2121 WEST RESERVATION LOOP ROAD
CAMP VERDE, AZ86322
Phone: 602-263-1200
Fax: 602-263-1618
Website:
Specialty Taxonomy Code
* Public Health or Welfare 251K00000X

* Indicates primary specialty

NPI Profile & details for DHEW IND HLTH SV HLTH SVS & MNTL HLTH ADM

NPI Number 1205859618
Legal business name
LBN
DHEW IND HLTH SV HLTH SVS & MNTL HLTH ADM
Authorized official LAURA TILLMAN - (CMO)
Entity Organization
Organization subpart No
Enumeration date 07/26/2006
Last updated 05/26/2021 - About 5 years ago
Sole proprietor1 Not specified
Identifiers
  • AZ Medicaid: 812869

1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

Reviews for DHEW IND HLTH SV HLTH SVS & MNTL HLTH ADM

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