Basic Information
| Provider Information | |||||||||
| NPI: | 1295992345 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NORTHERN COCHISE COMMUNITY HOSPITAL INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 901 W REX ALLEN DR | ||||||||
| Address2: | |||||||||
| City: | WILLCOX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 856431009 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5203843541 | ||||||||
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| Practice Location | |||||||||
| Address1: | 901 W REX ALLEN DR | ||||||||
| Address2: | |||||||||
| City: | WILLCOX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 856431009 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5203843541 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/16/2008 | ||||||||
| LastUpdateDate: | 05/16/2008 | ||||||||
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| AuthorizedOfficialLastName: | HILTON | ||||||||
| AuthorizedOfficialFirstName: | JULIE | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | ACTING ADMINISTRATOR AND CNO | ||||||||
| AuthorizedOfficialTelephone: | 5203843541 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | NORTHERN COCHISE COMMUNITY HOSPITAL INC | ||||||||
| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 313M00000X | NCI-301 | AZ | Y | Nursing & Custodial Care Facilities | Nursing Facility/Intermediate Care Facility |
ID Information
| ID | Type | State | Issuer | Description | 041179 | 05 | AZ | MEDICAID |