1750913364 NPI number — ARIZONA AUTISM UNITED, INC.

Table of content: (NPI 1750913364)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750913364 NPI number — ARIZONA AUTISM UNITED, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ARIZONA AUTISM UNITED, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
ARIZONA AUTISM UNITED - EAST VALLEY CENTER
Provider Other Organization Name Type Code:
5
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1750913364
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/16/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5025 E WASHINGTON ST STE 212
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PHOENIX
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85034-7439
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
602-773-5773
Provider Business Mailing Address Fax Number:
602-273-9108

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4309 E FLORIAN AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MESA
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85206-2798
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
602-773-5773
Provider Business Practice Location Address Fax Number:
602-273-9108
Provider Enumeration Date:
02/11/2020

Additional Information

Authorized Official

Authorized Official Last Name:
BLOCHER-RUBIN
Authorized Official First Name:
AARON
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
602-773-5774

Provider Taxonomy Codes

  • Taxonomy code: 103K00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 235Z00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 001060 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".




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