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Hwy 59 And Hc 61 P.o. 5050-ptt Edventures Program C/o Rough Rock High School Chinle AZ 86503 | |
(520) 907-6890 | |
(801) 944-2940 |
Full Name | |
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Speciality | Community/behavioral Health |
Location | Hwy 59 And Hc 61 P.o. 5050-ptt, Chinle, Arizona |
Authorized Official Name and Position | Siamak Khadjenoury (CEO) |
Authorized Official Contact | 5209076890 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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8848 Willow Hills Ct Sandy UT 84093-1889 Ph: (520) 907-6890 | Hwy 59 And Hc 61 P.o. 5050-ptt Edventures Program C/o Rough Rock High School Chinle AZ 86503 Ph: (520) 907-6890 |
NPI Number | 1790937548 |
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Provider Enumeration Date | 10/10/2008 |
Last Update Date | 10/10/2008 |
Identifier | Type | State | Issuer |
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1790937548 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
San Tan Behavioral Health Services Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 4600-c Navajo Route 7, Chinle, AZ 86503 Phone: 928-674-3931 Fax: 480-632-0026 | |