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#5 San Carlos Ave San Carlos AZ 85550-9999 | |
| (928) 475-4875 | |
| (928) 475-4880 |
| Full Name | |
|---|---|
| Speciality | Community/behavioral Health |
| Location | #5 San Carlos Ave, San Carlos, Arizona |
| Authorized Official Name and Position | Wendsler A Nosie (TRIBAL CHAIRMAN) |
| Authorized Official Contact | 9284752361 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
Po Box 0 San Carlos AZ 85550-9999 Ph: (928) 475-4875 | #5 San Carlos Ave San Carlos AZ 85550-9999 Ph: (928) 475-4875 |
| NPI Number | 1750456307 |
|---|---|
| Provider Enumeration Date | 11/21/2006 |
| Last Update Date | 07/01/2009 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1750456307 | NPI | - | NPPES |
| 624230 | Medicaid | AZ |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | 180-004505 (Illinois) | Secondary |
| 251S00000X | Community/behavioral Health | (Arizona) | Primary |
San Carlos Apache Wellness Center Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 5 San Carlos Ave, San Carlos, AZ 85550 Phone: 928-475-4875 | |