1710052915 NPI number — HUMANE SOCIETY OF SO 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 1710052915 NPI number — HUMANE SOCIETY OF SO ARIZONA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HUMANE SOCIETY OF SO 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:
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:
1710052915
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:
3450 N KELVIN BOULEVARD
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:
85716
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
520-881-7401
Provider Business Mailing Address Fax Number:
520-881-7400

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3450 N KELVIN BOULEVARD
Provider Second Line Business Practice Location Address:
HUMANE SOCIETY OF SOUTHERN ARIZONA
Provider Business Practice Location Address City Name:
TUCSON
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85716
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
520-881-7401
Provider Business Practice Location Address Fax Number:
520-881-7400
Provider Enumeration Date:
11/22/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MYERS
Authorized Official First Name:
MARSH
Authorized Official Middle Name:
FLINT
Authorized Official Title or Position:
DIR OF EDUCATION
Authorized Official Telephone Number:
520-881-7401

Provider Taxonomy Codes

  • Taxonomy code: 251V00000X , with the licence number:  CSA06ADHS01731 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 887143 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".




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