Organization
CANYONLANDS COMMUNITY HEALTH CARE
Active
Organization
CANYONLANDS COMMUNITY HEALTH CARE
Active
Parent organization
CANYONLANDS COMMUNITY HEALTH CARE
Other names
Kaibeto Clinic
Organization subpart
Yes
Provider details
NPI number
Legal business name
CANYONLANDS COMMUNITY HEALTH CARE
Authorized official
ELIZABETH G LATHAM (CEO)
(928) 645-9675
Entity
Organization
Contact information
Practice address
KAIBETO BOARDING SCHOOL DORM # 4, KAIBETO, AZ 86053-2121
(928) 673-3491
(928) 673-3494
Mailing address
PO BOX 1625, PAGE, AZ 86040-1625
(928) 645-9675
(928) 645-3030
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
432857
—
AZ
05
—
594045
—
AZ
Enumeration date
03/14/2006
Last updated
04/20/2008
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