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Organization
FORT DEFIANCE INDIAN HOSPITAL BOARD, INC.
Active
Organization
FORT DEFIANCE INDIAN HOSPITAL BOARD, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JENNIE GOULD (LICENSED PRACTICAL NURSE)
(928) 729-8030
Entity
Organization
Contact information
Practice address
CORNER OF ROUTE 12 & N7, FORT DEFIANCE, AZ 86504
(928) 729-8000
Mailing address
PO BOX 649, FORT DEFIANCE, AZ 86504-0649
(928) 729-8000
Taxonomy
Speciality
Code
Description
License number
State
281P00000X
Chronic Disease Hospital
Primary
LPO42607
AZ
Other
Enumeration date
06/24/2011
Last updated
06/24/2011
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