Provider Demographics
NPI:1528097896
Name:CATHOLIC COMMUNITY SERVICES OF SOUTHERN ARIZONA, INC.
Entity type:Organization
Organization Name:CATHOLIC COMMUNITY SERVICES OF SOUTHERN ARIZONA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:
Authorized Official - Last Name:CAVENDISH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-670-0800
Mailing Address - Street 1:140 W SPEEDWAY BLVD
Mailing Address - Street 2:SUITE 230
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85705-7686
Mailing Address - Country:US
Mailing Address - Phone:520-623-0344
Mailing Address - Fax:520-770-8514
Practice Address - Street 1:268 W ADAMS ST STE 230
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85705-6534
Practice Address - Country:US
Practice Address - Phone:520-623-0344
Practice Address - Fax:520-770-8514
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-30
Last Update Date:2024-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable
Provider Identifiers
StateIdentifier IDID TypeIssuer
Z105766OtherMEDICARE PTIN
Z105766OtherMEDICARE PTIN