Provider Demographics
NPI:1194781682
Name:PINAL COUNTY ARIZONA
Entity type:Organization
Organization Name:PINAL COUNTY ARIZONA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:FINANCE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:K
Authorized Official - Last Name:CHRISTIANSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-886-4500
Mailing Address - Street 1:PO BOX 2986
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:AZ
Mailing Address - Zip Code:85232-2986
Mailing Address - Country:US
Mailing Address - Phone:520-866-4500
Mailing Address - Fax:520-866-4529
Practice Address - Street 1:971 N JASON LOPEZ CIRCLE
Practice Address - Street 2:BLDG E
Practice Address - City:FLORENCE
Practice Address - State:AZ
Practice Address - Zip Code:85232-2986
Practice Address - Country:US
Practice Address - Phone:520-866-4500
Practice Address - Fax:520-866-4529
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-24
Last Update Date:2011-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZHHA0033251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ037028Medicare ID - Type Unspecified