Organization
CHEMEHUEVI INDIAN TRIBE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GLENN LODGE (TRIBAL CHAIRMAN)
(760) 858-4219
Entity
Organization
Contact information
Practice address
1970 PALO VERDE DRIVE, HAVASU LAKE, CA 92363-1976
(760) 858-5426
Mailing address
PO BOX 1976, HAVASU LAKE, CA 92363-1976
(760) 858-4219
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
—
—
Other
Enumeration date
05/09/2023
Last updated
05/09/2023
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