1962796219 NPI number — CATHEDRAL HEALTH SERVICES

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 1962796219 NPI number — CATHEDRAL HEALTH SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CATHEDRAL HEALTH SERVICES
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:
1962796219
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/03/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 16252
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PHOENIX
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85011-6252
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
602-254-7130
Provider Business Mailing Address Fax Number:
602-445-6343

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6390 E THOMAS RD
Provider Second Line Business Practice Location Address:
SUITE 218
Provider Business Practice Location Address City Name:
SCOTTSDALE
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85251-7051
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
602-254-7130
Provider Business Practice Location Address Fax Number:
602-445-6343
Provider Enumeration Date:
06/03/2011

Additional Information

Authorized Official

Authorized Official Last Name:
MATHER
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
L.
Authorized Official Title or Position:
FOUNDER
Authorized Official Telephone Number:
602-254-7130

Provider Taxonomy Codes

  • Taxonomy code: 251K00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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