Provider Demographics
NPI:1205547288
Name:CHIRICAHUA COMMUNITY HEALTH CENTERS, INC
Entity type:Organization
Organization Name:CHIRICAHUA COMMUNITY HEALTH CENTERS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:ABRAM
Authorized Official - Last Name:DRISCOLL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:520-459-3011
Mailing Address - Street 1:1100 N F AVE
Mailing Address - Street 2:
Mailing Address - City:DOUGLAS
Mailing Address - State:AZ
Mailing Address - Zip Code:85607-1919
Mailing Address - Country:US
Mailing Address - Phone:520-459-3012
Mailing Address - Fax:
Practice Address - Street 1:77 CALLE PORTAL STE C240
Practice Address - Street 2:
Practice Address - City:SIERRA VISTA
Practice Address - State:AZ
Practice Address - Zip Code:85635-2986
Practice Address - Country:US
Practice Address - Phone:520-515-8669
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-09
Last Update Date:2022-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)