1598928301 NPI number — GENERALCARE HEALTH SERVICES

Table of content: MARISOL ARIZA MS, LMHC., NCC, BCBA (NPI 1700028255)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598928301 NPI number — GENERALCARE HEALTH SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GENERALCARE HEALTH SERVICES
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:
GENERALCARE MEDICAL CLINIC
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:
1598928301
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/02/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
620 S LEMAY AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FORT COLLINS
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80524-3543
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
970-482-6620
Provider Business Mailing Address Fax Number:
970-482-6626

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
620 S LEMAY AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FORT COLLINS
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80524-3543
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
970-482-6620
Provider Business Practice Location Address Fax Number:
970-482-6626
Provider Enumeration Date:
07/02/2008

Additional Information

Authorized Official

Authorized Official Last Name:
VANSKIKE
Authorized Official First Name:
LORI
Authorized Official Middle Name:
ANN
Authorized Official Title or Position:
OFFICE ADMINISTRATOR
Authorized Official Telephone Number:
970-482-6620

Provider Taxonomy Codes

  • Taxonomy code: 261QX0100X , with the licence number:  20945 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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