Organization
BLACK CANYON COMMUNITY HEALTH CENTER, INC.
Active
Organization
BLACK CANYON COMMUNITY HEALTH CENTER, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RANDY CHARLES HANCOCK DO (CEO)
(623) 374-0200
Entity
Organization
Contact information
Practice address
17301 E SPRING VALLEY RD STE F, MAYER, AZ 86333-4263
(623) 374-0200
(623) 374-5576
Mailing address
PO BOX 12, BLACK CANYON CITY, AZ 85324-0012
(623) 374-0200
(623) 374-5576
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
207Q00000X
Family Medicine Physician
—
—
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Enumeration date
12/16/2022
Last updated
06/18/2026
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