Fort Defiance Outpatient Treatment Center
LBN: Fort Defiance Outpatient Treatment Center
Fort Defiance Outpatient Treatment Center is an health care organization with primary practice located at .5 Miles Sw Of The Fd Field House Bldg #6905 , Fort Defiance AZ 86504-1490. The organization recently has 2 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder), Agencies / Community/Behavioral Health. Agencies / Community/Behavioral Health is the primary health care specialty.
Fort Defiance Outpatient Treatment Center can be contacted via phone (928) 729-4012, or through Blatchford, Miranda via phone (928) 729-4012.
Contact Information
Primary practice address
.5 Miles Sw Of The Fd Field House Bldg #6905
Fort Defiance AZ 86504-1490
Phone: (928) 729-4012
Fax: (928) 729-4200
Website:
Authorized official contact:
Name: Blatchford, Miranda Licensed Clinical Social Worker (LCSW)
Phone: (928) 729-4012
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder) | 101YA0400X | ||
| Agencies / Community/Behavioral Health | 251S00000X |
Profile Details
| NPI number | 1740400365 |
|---|---|
| LBN Legal business name | Fort Defiance Outpatient Treatment Center |
| DBA Doing business as | |
| Authorized official | Blatchford, Miranda Licensed Clinical Social Worker (LCSW) |
| Entity | Organization |
| Organization subpart 1 | No |
| Enumeration date | Apr 26th, 2007 |
| Last updated | Mar 10th, 2022 - about 2 years ago |
1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1740400365 | NPPES |
| Arizona | MEDICAID | 329541 |
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