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
19251 E OASIS DR, BLACK CANYON CITY, AZ 85324-8878
(623) 374-0200
(623) 374-5576
Mailing address
PO BOX 1958, BLACK CANYON CITY, AZ 85324-1958
(623) 374-0200
(623) 374-5576
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
207QA0000X
Adolescent Medicine (Family Medicine) Physician
—
—
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Enumeration date
07/08/2022
Last updated
06/18/2026
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