Provider Demographics
NPI:1891926721
Name:RONALD MCDONALD HOUSE CHARITIES OF SOUTHERN ARIZONA
Entity type:Organization
Organization Name:RONALD MCDONALD HOUSE CHARITIES OF SOUTHERN ARIZONA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:MR
Authorized Official - First Name:MATT
Authorized Official - Middle Name:
Authorized Official - Last Name:HITCHCOCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-326-0060
Mailing Address - Street 1:PO BOX 20725
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85717
Mailing Address - Country:US
Mailing Address - Phone:520-326-0060
Mailing Address - Fax:520-881-1732
Practice Address - Street 1:3838 N CAMPBELL AVE
Practice Address - Street 2:BUILDING #6
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85719-1478
Practice Address - Country:US
Practice Address - Phone:520-326-0060
Practice Address - Fax:520-881-1732
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-27
Last Update Date:2009-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes177F00000XOther Service ProvidersLodgingGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ423852OtherAHCCCS PROVIDER NUMBER