Provider Demographics
NPI:1245491653
Name:HOZHO NAHASDLII HEALTH CARE AT HOME
Entity type:Organization
Organization Name:HOZHO NAHASDLII HEALTH CARE AT HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ONWER
Authorized Official - Prefix:
Authorized Official - First Name:CALVINA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:BEGAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-729-2085
Mailing Address - Street 1:PO BOX 793
Mailing Address - Street 2:NAVAJO ROUTE12 MILE MARKER 34
Mailing Address - City:FORT DEFIANCE
Mailing Address - State:AZ
Mailing Address - Zip Code:86504-0793
Mailing Address - Country:US
Mailing Address - Phone:928-729-2085
Mailing Address - Fax:928-729-2050
Practice Address - Street 1:3629 MILE MARKER 34 NAVAJO ROUTE 12
Practice Address - Street 2:
Practice Address - City:FORT DEFIANCE
Practice Address - State:AZ
Practice Address - Zip Code:86504-0793
Practice Address - Country:US
Practice Address - Phone:928-729-2085
Practice Address - Fax:928-729-2050
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-18
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ328044251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ328044Medicaid