1922166107 NPI number — COYOTE TASK FORCE

Table of content: (NPI 1922166107)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922166107 NPI number — COYOTE TASK FORCE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COYOTE TASK FORCE
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:
OUR PLACE CLUBHOUSE
Provider Other Organization Name Type Code:
3
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:
1922166107
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/08/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
66 E PENNINGTON STREET, COYOTE TASKFORCE CORP
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TUCSON
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85701
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
520-884-5553
Provider Business Mailing Address Fax Number:
520-670-1496

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
66 E PENNINGTON STREET, COYOTE TASKFORCE CORP
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TUCSON
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85701
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
520-884-5553
Provider Business Practice Location Address Fax Number:
520-670-1496
Provider Enumeration Date:
12/04/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
GROBE
Authorized Official First Name:
JEFF
Authorized Official Middle Name:
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
520-886-5553

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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