Provider Demographics
NPI:1861124505
Name:AK-CHIN INDIAN COMMUNITY
Entity type:Organization
Organization Name:AK-CHIN INDIAN COMMUNITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PURCHASED/REFERRED CARE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CONCEPCION
Authorized Official - Middle Name:
Authorized Official - Last Name:MIGUEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-568-1795
Mailing Address - Street 1:P.O. BOX 123
Mailing Address - Street 2:
Mailing Address - City:MARICOPA
Mailing Address - State:AZ
Mailing Address - Zip Code:85139
Mailing Address - Country:US
Mailing Address - Phone:520-568-1088
Mailing Address - Fax:520-568-1042
Practice Address - Street 1:47314 W. FARRELL ROAD
Practice Address - Street 2:
Practice Address - City:MARICOPA
Practice Address - State:AZ
Practice Address - Zip Code:85139
Practice Address - Country:US
Practice Address - Phone:520-568-1088
Practice Address - Fax:520-568-1042
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AK-CHIN INDIAN COMMUNITY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-06-30
Last Update Date:2022-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty