Organization Name: | SUN LIFE FAMILY HEALTH CENTER, INC. |
NPI Number: | 1033321989 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | DONELLE HOLLEVOET (CREDENTIALING SPECIALIST) |
Mailing Address: | 1284 North Arizona Road Coolidge |
State: | AZ US |
Postal Code: | 85228 |
Phone Number: | 5207239131 |
Fax Number: | 5207237974 |
NPI Enumeration Date: | 05/04/2007 |
NPI Last Update Date: | 07/12/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QF0400X |
License Number: | 920 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | AZ |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Federally Qualified Health Center (FQHC) |
Taxonomy Definition: |