Basic Information
| Provider Information | |||||||||
| NPI: | 1548794142 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | AJO COMMUNITY HEALTH CENTER | ||||||||
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| OtherOrganizationName: | DESERT SENITA COMMUNITY HEALTH CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 410 N MALACATE ST | ||||||||
| Address2: | |||||||||
| City: | AJO | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 853212254 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5203875651 | ||||||||
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| Practice Location | |||||||||
| Address1: | 14574 S. SUNLAND GIN RD | ||||||||
| Address2: | |||||||||
| City: | ARIZONA CITY | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 85123 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5203875651 | ||||||||
| FaxNumber: | 5203876036 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/20/2017 | ||||||||
| LastUpdateDate: | 10/12/2022 | ||||||||
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| AuthorizedOfficialLastName: | LEONARD | ||||||||
| AuthorizedOfficialFirstName: | JONATHAN | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 5203875651 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 10/12/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QF0400X | N | Ambulatory Health Care Facilities | Clinic/Center | Federally Qualified Health Center (FQHC) | 261QF0400X | AZ | Y | Ambulatory Health Care Facilities | Clinic/Center | Federally Qualified Health Center (FQHC) |
No ID Information.