- Enrollment id
- O20240319000907
- Enrollment state
- AZ
- Provider type code
- 00-04
- Provider type text
- PART A PROVIDER - FEDERALLY QUALIFIED HEALTH CENTER (FQHC)
- Npi
- 1184407546
- Multiple npi flag
- N
- Ccn
- 031036
- Associate id
- 5395638878
- Organization name
- CHIRICAHUA COMMUNITY HEALTH CENTERS INC
- Doing business as name
- SIERRA VISTA BEHAVIORAL HEALTH CENTER
- Incorporation date
- 2023-01-01
- Incorporation state
- AZ
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- N
- Address line 1
- 77 CALLE PORTAL
- Address line 2
- STE A140
- City
- SIERRA VISTA
- State
- AZ
- Zip code
- 856352988
- Telephone number
- 5205158669