Canoncito Band of Navajos Health Center, Inc.
Organization Active NPI Rural Health Clinic/Center · Tohajiilee, NM
NPI 1578010070 · NPPES record last updated Feb 1, 2017
Key facts
- NPI
- 1578010070
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Rural Health Clinic/Center 261QR1300X
- Legal business name
- CANONCITO BAND OF NAVAJOS HEALTH CENTER, INC.
- Practice address
- 129 Medicine Horse Drive
Tohajiilee, NM 87026 - Phone
- (505) 908-2307
- Fax
- (505) 908-2310
- NPI assigned
- Sep 1, 2016
- Organization subpart
- Yes
- Parent organization (as reported)
- CANONCITO BAND OF NAVAJOS HEALTH CENTER, INC.
Authorized official
- Name
- Mrs. Beverly Lewis
- Title
- Business Office
- Phone
- (505) 908-2307
Owners & managing parties with NPI records 1
Other NPIs with the same Medicare PAC ID 1
Practitioners 23
-
Kerry A Hile, O.D.
-
Sheryl Ann O'Shea, M.D.
-
Julianna Jean Reece, M.D.
-
Dathan Tsosie, MD
-
Elaine Little, R.D.
-
Elizabeth Cumby, MD
-
Roberto Carlos Montes, PSY.D
-
Jennifer M Pas, R.D., L.D.
-
Kenneth Rodriguez, DDS
-
Emily Rothman, DO
-
Robert C Salek, D.P.M.
-
Valencia Zah, LCSW
-
David Charles Feist, DDS
-
Romilly Ortiz, PA
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in TX, NM
Federally qualified health center certification: CCN 321964
- Legal name
- CANONCITO BAND OF NAVAJOS HEALTH CENTER, INC
- Doing business as
- CBN HEALTH CENTER INC
- Certification status
- Active
- Provider type (POS)
- Federally qualified health center
- Participating since
- Mar 12, 2019
- Last certification
- Mar 12, 2019
- Ownership / control type
- For profit – corporation
- Organization structure
- Other · Non-profit
- Incorporated
- Sep 29, 2003 in NM
- Enrollment address
- 129 Medicine Horse Dr
PO Box 3338
Tohajiilee, NM 87026-3338
All disclosed owners & managing parties 2
| Name | Role | Since | Share |
|---|---|---|---|
| John H Billison |
Contracted Managing Employee |
Oct 2, 2025 | |
| W-2 Managing Employee |
Oct 2, 2025 | ||
| Operational/Managerial Control | Oct 2, 2025 | ||
| Canoncito Band of Navajos Health Center, Inc |
5% Or Greater Direct Ownership Interest | Sep 29, 2003 | 100% |
| Operational/Managerial Control | Sep 29, 2003 | 100% |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20170425001197 | TX | Part B Supplier - Clinic/Group Practice | 8325321235 |
Receives reassigned benefits from 23 practitioners Practice locations: Tohajiilee, NM |
| O20190312002408 | NM | Part a Provider - Federally Qualified Health Center (FQHC) | 8325321235 | Practice locations: Tohajiilee, NM |
National Provider Directory
- Part of
- Canoncito Band of Navajos Health Center Inc
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Rural Health Clinic/Center | 261QR1300X | Yes |
Addresses
Primary practice location
129 Medicine Horse Drive
Tohajiilee, NM 87026
Mailing address
129 Medicine Horse Drive
Tohajiilee, NM 87026
Phone (505) 908-2307
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 91286018 | Medicaid | NM |
Other names
- CBN Health Center, Inc
Other providers in Tohajiilee, NM
- Lisa Danelle Begay
- Alfred B Benalli
- Canoncito Band of Navajo Health Center, Inc
- Canoncito Band of Navajos Health Center
- Canoncito Band of Navajos Health Center, Inc.
- Elizabeth Cumby
- Raelene J Danny
- Brennia Delacruz
- Tyrone Etsitty
- Judith Gould
All providers in Tohajiilee, NM · Rural Health Clinic/Center in New Mexico
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 1, 2017. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.