1932530797 NPI number — EASTER SEALS BLAKE FOUNDATION

Table of content: (NPI 1932530797)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932530797 NPI number — EASTER SEALS BLAKE FOUNDATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EASTER SEALS BLAKE FOUNDATION
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:
BLAKE FOUNDATION
Provider Other Organization Name Type Code:
4
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:
1932530797
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/22/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7756 E BROADWAY BLVD STE A100
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:
85710-4022
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
520-449-8555
Provider Business Mailing Address Fax Number:
520-204-6808

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7756 E BROADWAY BLVD STE C100
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TUCSON
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85710-4022
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
520-327-1529
Provider Business Practice Location Address Fax Number:
520-514-9878
Provider Enumeration Date:
12/04/2013

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
ARENDT
Authorized Official First Name:
MARISSA
Authorized Official Middle Name:
S
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
520-327-1529

Provider Taxonomy Codes

  • Taxonomy code: 251B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: OTC-6111 . This is a "AZ DEPT OF HEALTH SERVICES LICENSE" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 885160 . This is a "AHCCCS PROVIDER" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 885160 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".