NPIMap

Organization Active NPI

Canyonlands Community Health Care

Doing business as Canyonlands Health Care - Safford Integrated

  • Federally Qualified Health Center (FQHC)
  • Safford, AZ
National Provider Identifier
1144755182
Registry record updated Sep 23, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
License
OTC7466 Issued in AZ
Legal business name
CANYONLANDS COMMUNITY HEALTH CARE
Doing business as
Canyonlands Health Care - Safford Integrated
Practice address
1615 S 1St Ave
Safford, AZ 85546-2103
Phone
(928) 348-1708
NPI assigned
Apr 27, 2017
Last updated
Sep 23, 2021By the provider in NPPES
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 Hansen
Title
Ceo
Phone
(928) 645-9675

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X OTC7466 AZ Primary

Addresses

Primary practice location

1615 S 1St Ave
Safford, AZ 85546-2103

Mailing address

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

Other identifiers 3

IdentifierTypeStateIssuer
031811OtherCORPORATE PTAN
OTC7466OtherAZSTATE FACILITY LICENSE
1609966860OtherCORPORATE NPI

Other names 1

  • Canyonlands Health Care - Safford Integrated 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
O20170629001899 AZ Part A Provider - Federally Qualified Health Center (FQHC) 4082509591 Practice locations: Safford, AZ

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1144755182. Details of each certification follow.

Federally qualified health center certification: CCN 031952

Legal name
CANYONLANDS COMMUNITY HEALTH CARE
Doing business as
CANYONLANDS HEALTH CARE-SAFFORD INTEGRATED
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
May 2, 2017
Last certification
May 2, 2017
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Feb 6, 1975 in AZ
Enrollment address
1615 S 1St Ave
Safford, AZ 85546-2103

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 Cen15 organizations share this tax ID, including this one
Part of
Lake Powell Medical Cen

Other organizations with this tax ID 14

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

View all 14

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
Richard Baker Individual Corporate Director Dec 16, 2016
Judith Brittain Individual Corporate DirectorBoard Member Sep 1, 2023
Holly Smith Individual W-2 Managing EmployeeCfo Jan 1, 2016
Justine Holguin Individual Other Aug 1, 2020
William Justice Individual Corporate Director Dec 16, 2016
Christopher Hansen Individual Corporate OfficerCeo Jan 1, 2015
W-2 Managing EmployeeCeo Jan 1, 2015
Thomas Bradley Individual Corporate Director Oct 17, 2009
Tom Maikowski Individual Corporate Director Dec 16, 2016
Paulette Leblanc Individual Corporate Director Dec 16, 2016

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1493251200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1632355200000",
    "number": "1144755182",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1625",
            "city": "PAGE",
            "state": "AZ",
            "postal_code": "860401625",
            "telephone_number": "928-645-9675",
            "fax_number": "928-645-2626"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1615 S 1ST AVE",
            "city": "SAFFORD",
            "state": "AZ",
            "postal_code": "855462103",
            "telephone_number": "928-348-1708"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CANYONLANDS COMMUNITY HEALTH CARE",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CANYONLANDS COMMUNITY HEALTH CARE",
        "enumeration_date": "2017-04-27",
        "last_updated": "2021-09-23",
        "certification_date": "2021-09-23",
        "status": "A",
        "authorized_official_last_name": "HANSEN",
        "authorized_official_first_name": "CHRISTOPHER",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "928-645-9675"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "AZ",
            "license": "OTC7466",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CORPORATE PTAN",
            "identifier": "031811",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE FACILITY LICENSE",
            "identifier": "OTC7466",
            "state": "AZ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CORPORATE NPI",
            "identifier": "1609966860",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Canyonlands Health Care - Safford Integrated",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Safford, AZ

Sources for this page

Verify at the official NPI Registry.