NPI 1104112655

Havasupai Tribe Head Start

Organisation Community Health Worker Supai, AZ

Practice location

Address: 130 Main St., Supai, AZ 86435-0130
Phone: (928) 448-2821
Fax: (928) 448-2341
Mailing address: PO Box 130, Supai, AZ 86435-0130

Authorised official

Name: Jacqueline K. Siyuja
Title: Health Coordinator
Phone: (928) 448-2821

Registered specialties

Community Health Worker Primary

Other Service Providers Taxonomy 172V00000X Licence 172V00000X (AZ)

Other Community Health Worker providers in Arizona →

Registry record

NPI: 1104112655
Entity type: Organization
NPI issued: 23 Jun 2011
Record last updated: 23 Jun 2011

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.