1912061508 NPI number — CROSSROADS RESCUE MISSION

Table of content: (NPI 1912061508)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912061508 NPI number — CROSSROADS RESCUE MISSION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CROSSROADS RESCUE MISSION
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:
Provider Other Organization Name Type Code:
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:
1912061508
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/09/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P.O. BOX 1161
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
YUMA
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85366
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
928-726-0491
Provider Business Mailing Address Fax Number:
928-314-0717

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
944 S ARIZONA AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
YUMA
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85364-3947
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
928-783-9362
Provider Business Practice Location Address Fax Number:
928-329-6020
Provider Enumeration Date:
12/20/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
GARLIT
Authorized Official First Name:
MYRA
Authorized Official Middle Name:
E.
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
928-783-9362

Provider Taxonomy Codes

  • Taxonomy code: 324500000X , with the licence number:  BH-1142 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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