NPI 1073787768

La Casa Serena

Organisation Health Maintenance Organization Eagar, AZ

Practice location

Address: 324 East 1st Street, Eagar, AZ 85925-0609
Phone: (928) 333-0151
Fax: (928) 333-0154
Mailing address: 324 E 1st Street, Eagar, AZ 85925-0609

Authorised official

Name: Eric Lee Hamblin
Title: Owner
Phone: (928) 333-0151

Registered specialties

Health Maintenance Organization Primary

Managed Care Organizations Taxonomy 302R00000X Licence AL6954 (AZ)

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Registry record

NPI: 1073787768
Entity type: Organization
NPI issued: 15 Apr 2008
Record last updated: 15 Apr 2008

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.