Organization
GILA RIVER INDIAN COMMUNITY DEPARTMENT OF HUMAN SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. GLENN THOMAS CUMMINGS MA, LISAC, LPC (DIRECTOR)
(520) 796-3802
Entity
Organization
Contact information
Practice address
3850 N. 16 STREET, LAVEEN, AZ 85339
(520) 796-3860
(520) 796-3801
Mailing address
PO BOX 602, LAVEEN, AZ 85339-0602
(520) 796-3860
(520) 796-3801
Taxonomy
Speciality
Code
Description
License number
State
324500000X
Substance Abuse Rehabilitation Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
074165
ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM
AZ
01
—
411673
ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM
AZ
Enumeration date
04/06/2009
Last updated
04/06/2009
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