Organization
DHHS IHS PHOENIX AREA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROSEMARY SULLIVAN RN, BSN (HEALTH SYSTEM ADMINISTRATOR)
(928) 769-2900
Entity
Organization
Contact information
Practice address
943 HUALAPAI WAY, PEACH SPRINGS, AZ 86434-0190
(928) 769-2900
(928) 769-2701
Mailing address
PO BOX 190, PEACH SPRINGS, AZ 86434-0190
(928) 769-2900
(928) 769-2701
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
092411
—
AZ
Enumeration date
11/14/2007
Last updated
03/30/2012
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