Organization
FORT DEFIANCE INDIAN HOSPITAL BOARD, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JENNIE GOULD (LICENSED PRACTICAL NURSE)
(928) 729-8030
Entity
Organization
Contact information
Practice address
CORNER OF ROUTE 12 & N7, FORT DEFIANCE, AZ 86504
(928) 729-8000
Mailing address
PO BOX 649, FORT DEFIANCE, AZ 86504-0649
(928) 729-8000
Taxonomy
Speciality
Code
Description
License number
State
281P00000X
Chronic Disease Hospital
Primary
LPO42607
AZ
Other
Enumeration date
06/24/2011
Last updated
06/24/2011
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