Provider Demographics
NPI:1710052915
Name:HUMANE SOCIETY OF SO ARIZONA
Entity type:Organization
Organization Name:HUMANE SOCIETY OF SO ARIZONA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIR OF EDUCATION
Authorized Official - Prefix:MR
Authorized Official - First Name:MARSH
Authorized Official - Middle Name:FLINT
Authorized Official - Last Name:MYERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-881-7401
Mailing Address - Street 1:3450 N KELVIN BOULEVARD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85716
Mailing Address - Country:US
Mailing Address - Phone:520-881-7401
Mailing Address - Fax:520-881-7400
Practice Address - Street 1:3450 N KELVIN BOULEVARD
Practice Address - Street 2:HUMANE SOCIETY OF SOUTHERN ARIZONA
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85716
Practice Address - Country:US
Practice Address - Phone:520-881-7401
Practice Address - Fax:520-881-7400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZCSA06ADHS01731251V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ887143Medicaid