| Organization Name: | NORTHERN ARIZONA HEALTHCARE PROVIDER GROUP, LLC |
| NPI Number: | 1033556089 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | HOPE WADE (INTERIM CFO) |
| Mailing Address: | 269 South Candy Lane Cottonwood |
| State: | AZ US |
| Postal Code: | 863264158 |
| Phone Number: | 9286396450 |
| Fax Number: | 9282141071 |
| NPI Enumeration Date: | 05/31/2013 |
| NPI Last Update Date: | 09/07/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 2084P0805X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | Psychiatry & Neurology |
| Taxonomy Specialization: | Geriatric Psychiatry |
| Taxonomy Definition: | Geriatric Psychiatry is a subspecialty with psychiatric expertise in prevention, evaluation, diagnosis and treatment of mental and emotional disorders in the elderly, and improvement of psychiatric care for healthy and ill elderly patients. |