NPIMap

Organization Active NPI

Canyonlands Community Health Care

  • Federally Qualified Health Center (FQHC)
  • Clifton, AZ
National Provider Identifier
1134568660
Registry record updated Sep 23, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
CANYONLANDS COMMUNITY HEALTH CARE
Practice address
10 Ward Canyon Road
#A
Clifton, AZ 85533
Phone
(928) 645-9675
NPI assigned
Jun 18, 2013
Organization subpart
Yes
Parent organization
CANYONLANDS COMMUNITY HEALTH CAREAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 23, 2021

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

Authorized official

Name
Christopher J Hansen
Title
Chief Executive Officer
Phone
(928) 645-9675

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

10 Ward Canyon Road
#A
Clifton, AZ 85533

Mailing address

PO Box 1625
827 Vista Ave
Page, AZ 86040-1625
Phone (928) 645-9675

Other identifiers 1

IdentifierTypeStateIssuer
031811OtherAZCORPORATE PTAN

Other names 1

  • Canyonlands Health Care - Clifton Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040219000713 AZ Part B Supplier - Clinic/Group Practice 4082509591 Receives reassigned benefits from 42 practitioners
14 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Safford, AZ; Pima, AZ; Page, AZ; Globe, AZ; Duncan, AZ; Clifton, AZ; Chilchinbito, AZ; Beaver Dam, AZ
O20141205000423 AZ Part A Provider - Federally Qualified Health Center (FQHC) 4082509591 1 other NPI on this enrollment
Practice locations: Clifton, AZ

Federally qualified health center certification: CCN 031920

Legal name
CANYONLANDS COMMUNITY HEALTH CARE
Doing business as
CANYONLANDS HEALTHCARE CLIFTON
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Dec 4, 2014
Last certification
Dec 4, 2014
Ownership / control type
Non-profit – church related
Organization structure
CorporationNon-profit
Incorporated
Feb 6, 1975 in AZ
Enrollment address
10A Ward Canyon Rd
Clifton, AZ 85533-8233

Other NPIs with the same Medicare PAC ID 10

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 12

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Lake Powell Medical Center15 organizations share this tax ID, including this one
Part of
Lake Powell Medical Center

Other organizations with this tax ID 14

Organizations that report the same tax identification number in the National Provider Directory.

View all 14

Locations

10 Ward Canyon Rd
#A
Clifton, AZ 85533
Phone (928) 645-9675

Ownership & related parties

All disclosed owners & managing parties 10

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Janice Lovett Individual Other Jul 1, 2016
Marcie Larson Individual Other May 1, 2019
Judith Brittain Individual Corporate DirectorBoard Member Sep 1, 2023
Holly Smith Individual Corporate OfficerCfo Jan 1, 2016
Justine Holguin Individual Other Aug 1, 2020
William Justice Individual Other Mar 25, 2015
Christopher Hansen Individual Corporate OfficerCeo Jan 1, 2016
W-2 Managing Employee Jan 1, 2016 5%
Thomas Bradley Individual Other Nov 19, 2014
Tom Maikowski Individual Other Feb 17, 2015
Paulette Leblanc Individual Other Feb 26, 2014

Practitioners & affiliated clinicians

Practitioners 45

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 45

NPI Registry JSON

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

{
    "created_epoch": "1371513600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1632355200000",
    "number": "1134568660",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1625",
            "address_2": "827 VISTA AVE",
            "city": "PAGE",
            "state": "AZ",
            "postal_code": "860401625",
            "telephone_number": "928-645-9675"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10 WARD CANYON ROAD",
            "address_2": "#A",
            "city": "CLIFTON",
            "state": "AZ",
            "postal_code": "85533",
            "telephone_number": "928-645-9675"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CANYONLANDS COMMUNITY HEALTH CARE",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CANYONLANDS COMMUNITY HEALTH CARE",
        "enumeration_date": "2013-06-18",
        "last_updated": "2021-09-23",
        "certification_date": "2021-09-23",
        "status": "A",
        "authorized_official_last_name": "HANSEN",
        "authorized_official_first_name": "CHRISTOPHER",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "928-645-9675"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CORPORATE PTAN",
            "identifier": "031811",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Canyonlands Health Care - Clifton",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Clifton, AZ

Sources for this page

Verify at the official NPI Registry.