Provider Demographics
NPI:1144336041
Name:HIGHLAND NAVAJO OUTREACH
Entity type:Organization
Organization Name:HIGHLAND NAVAJO OUTREACH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:FRAN
Authorized Official - Middle Name:
Authorized Official - Last Name:GEORGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-786-7550
Mailing Address - Street 1:PO BOX 1078
Mailing Address - Street 2:
Mailing Address - City:THOREAU
Mailing Address - State:NM
Mailing Address - Zip Code:87323-1078
Mailing Address - Country:US
Mailing Address - Phone:505-786-7550
Mailing Address - Fax:505-786-7551
Practice Address - Street 1:8.5 MI N. OF THOREAU HWY 371
Practice Address - Street 2:RR881A
Practice Address - City:THOREAU
Practice Address - State:NM
Practice Address - Zip Code:87323-1078
Practice Address - Country:US
Practice Address - Phone:505-786-7550
Practice Address - Fax:505-786-7551
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM3578251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM02-946546-00Medicaid