Organization Name: | AJO COMMUNITY HEALTH CENTER |
NPI Number: | 1174844823 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | FATIMA MCCASLAND (CHIEF EXECUTIVE OFFICER) |
Mailing Address: | 410 N Malacate St Ajo |
State: | AZ US |
Postal Code: | 853212254 |
Phone Number: | 5203875651 |
Fax Number: | 5203875347 |
NPI Enumeration Date: | 06/17/2010 |
NPI Last Update Date: | 06/17/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QM0801X |
License Number: | BH1966 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | AZ |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Mental Health (Including Community Mental Health Center) |
Taxonomy Definition: |