1508838517 NPI number — CATHOLIC COMMUNITY SERVICES IN SOUTHERN ARIZONA

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508838517 NPI number — CATHOLIC COMMUNITY SERVICES IN SOUTHERN ARIZONA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CATHOLIC COMMUNITY SERVICES IN SOUTHERN ARIZONA
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:
1508838517
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1777
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BISBEE
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85603-2777
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
520-432-2285
Provider Business Mailing Address Fax Number:
520-432-2009

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
#19 HOWELL AVENUE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BISBEE
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85603
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
520-432-2285
Provider Business Practice Location Address Fax Number:
520-432-2009
Provider Enumeration Date:
02/03/2006

Additional Information

Authorized Official

Authorized Official Last Name:
PORTER
Authorized Official First Name:
RADI ANN
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR HOME HEALTH PROGRAM
Authorized Official Telephone Number:
520-432-2285

Provider Taxonomy Codes

  • Taxonomy code: 163WH0200X , with the licence number:  HHA0112 ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 652190 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".




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