NPIMap

Organization Active NPI

Havasupai Tribe Head Start

  • Community Health Worker
  • Supai, AZ
National Provider Identifier
1104112655
Registry record updated Jun 23, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Health WorkerTaxonomy code 172V00000X
License
172V00000X Issued in AZ
Legal business name
HAVASUPAI TRIBE HEAD START
Practice address
130 Main St.
Supai, AZ 86435-0130
Phone
(928) 448-2821
Fax
(928) 448-2341
NPI assigned
Jun 23, 2011
Last updated
Jun 23, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 23, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community Health Worker 172V00000X 172V00000X AZ Primary

Addresses

Primary practice location

130 Main St.
Supai, AZ 86435-0130

Mailing address

PO Box 130
Supai, AZ 86435-0130
Phone (928) 448-2821

National Provider Directory

National Provider Directory

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1308787200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1308787200000",
    "number": "1104112655",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 130",
            "city": "SUPAI",
            "state": "AZ",
            "postal_code": "864350130",
            "telephone_number": "928-448-2821",
            "fax_number": "928-448-2341"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "130 MAIN ST.",
            "city": "SUPAI",
            "state": "AZ",
            "postal_code": "864350130",
            "telephone_number": "928-448-2821",
            "fax_number": "928-448-2341"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HAVASUPAI TRIBE HEAD START",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-06-23",
        "last_updated": "2011-06-23",
        "status": "A",
        "authorized_official_last_name": "SIYUJA",
        "authorized_official_first_name": "JACQUELINE",
        "authorized_official_middle_name": "K.",
        "authorized_official_title_or_position": "HEALTH COORDINATOR",
        "authorized_official_telephone_number": "928-448-2821",
        "authorized_official_name_prefix": "Miss"
    },
    "taxonomies": [
        {
            "code": "172V00000X",
            "taxonomy_group": "",
            "desc": "Community Health Worker",
            "state": "AZ",
            "license": "172V00000X",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Supai, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 23, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.