Provider Demographics
NPI:1972968360
Name:UNITED COMMUNITY HEALTH CENTER - MARIA AUXILIADORA, INC.
Entity type:Organization
Organization Name:UNITED COMMUNITY HEALTH CENTER - MARIA AUXILIADORA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:RODOLFO
Authorized Official - Middle Name:
Authorized Official - Last Name:JIMENEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:520-407-5600
Mailing Address - Street 1:1260 S CAMPBELL AVE
Mailing Address - Street 2:BLDG. 2
Mailing Address - City:GREEN VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85614-0503
Mailing Address - Country:US
Mailing Address - Phone:520-407-5606
Mailing Address - Fax:520-625-8504
Practice Address - Street 1:4475 S I 19 FRONTAGE RD
Practice Address - Street 2:STE 139
Practice Address - City:GREEN VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85614-5884
Practice Address - Country:US
Practice Address - Phone:520-407-5606
Practice Address - Fax:520-625-8504
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UNITED COMMUNITY HEALTH CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-12-29
Last Update Date:2020-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ6491261QF0400X
261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty