| Organization Name: | NORTH COUNTRY HEALTHCARE, INC. |
| NPI Number: | 1033359468 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | ANN M ROGGENBUCK (CEO) |
| Mailing Address: | 2090 North Smoketree Ave Lake Havasu City |
| State: | AZ US |
| Postal Code: | 864035806 |
| Phone Number: | 9288541800 |
| Fax Number: | 9288541818 |
| NPI Enumeration Date: | 02/25/2009 |
| NPI Last Update Date: | 07/17/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QM1300X |
| License Number: | OTC4587 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | AZ |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Multi-Specialty |
| Taxonomy Definition: | |