1649356114 NPI number — FOR HEALTH OF ARIZONA, INC.

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 1649356114 NPI number — FOR HEALTH OF ARIZONA, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FOR HEALTH OF ARIZONA, 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:
1649356114
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:
10 CADILLAC DR
Provider Second Line Business Mailing Address:
SUITE 350
Provider Business Mailing Address City Name:
BRENTWOOD
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37027-5078
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-986-9201
Provider Business Mailing Address Fax Number:
615-986-9256

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2025 N 3RD ST
Provider Second Line Business Practice Location Address:
SUITE 170
Provider Business Practice Location Address City Name:
PHOENIX
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85004-1471
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
602-462-1132
Provider Business Practice Location Address Fax Number:
602-462-1186
Provider Enumeration Date:
10/27/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
STANLEY
Authorized Official First Name:
KIRK
Authorized Official Middle Name:
M
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
615-986-9226

Provider Taxonomy Codes

  • Taxonomy code: 363LG0600X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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