Basic Information
| Provider Information | |||||||||
| NPI: | 1538343579 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | CANONCITO BAND OF NAVAJO HEALTH CENTER, INC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | TO'HAJIILEE BEHAVIIORAL HEALTH SYSTEM | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 3368 | ||||||||
| Address2: | 96 MEDICINE HORSE DR. | ||||||||
| City: | TOHAJIILEE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 870263368 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5059082571 | ||||||||
| FaxNumber: | 5059082572 | ||||||||
| Practice Location | |||||||||
| Address1: | 96 MEDICINE HORSE DR. | ||||||||
| Address2: | |||||||||
| City: | TO'HAJIILEE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 87026 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5059082871 | ||||||||
| FaxNumber: | 5059082572 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/27/2007 | ||||||||
| LastUpdateDate: | 07/07/2014 | ||||||||
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| AuthorizedOfficialLastName: | PLATERO | ||||||||
| AuthorizedOfficialFirstName: | JIM | ||||||||
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| AuthorizedOfficialTitleorPosition: | EXECUTIVE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 5059082037 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | 0131581 | NM | Y | Agencies | Community/Behavioral Health |
No ID Information.