1457459091 NPI number — COMMUNITY PARTNERS INTEGRATED HEALTHCARE, INC.

Table of content: (NPI 1457459091)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457459091 NPI number — COMMUNITY PARTNERS INTEGRATED HEALTHCARE, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COMMUNITY PARTNERS INTEGRATED HEALTHCARE, 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:
Provider Other Organization Name Type Code:
6
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:
1457459091
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/20/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 86537
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:
85754-6537
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
520-721-1887
Provider Business Mailing Address Fax Number:
520-721-0069

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2545 S ARIZONA AVE
Provider Second Line Business Practice Location Address:
BLDG A-D
Provider Business Practice Location Address City Name:
YUMA
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85364-7364
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
928-376-0220
Provider Business Practice Location Address Fax Number:
928-344-2861
Provider Enumeration Date:
09/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
LOPEZ
Authorized Official First Name:
ROSE
Authorized Official Middle Name:
MARY
Authorized Official Title or Position:
PRESIDENT AND CEO
Authorized Official Telephone Number:
520-721-1887

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X , with the licence number:  OTC8057 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QM1300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 231843 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: OTC8057 . This is a "BUREAU OF MEDICAL FACILITIES LICENSING" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".




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