Provider Demographics
NPI:1982858338
Name:ARIZONA TRAINING PROGRAM @ COOLIDGE
Entity type:Organization
Organization Name:ARIZONA TRAINING PROGRAM @ COOLIDGE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ZANE
Authorized Official - Middle Name:
Authorized Official - Last Name:GARCIA RAMADAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-490-6857
Mailing Address - Street 1:2800 N HIGHWAY 87
Mailing Address - Street 2:
Mailing Address - City:COOLIDGE
Mailing Address - State:AZ
Mailing Address - Zip Code:85128-9460
Mailing Address - Country:US
Mailing Address - Phone:520-723-2600
Mailing Address - Fax:602-364-1322
Practice Address - Street 1:2800 N. HIGHWAY 87
Practice Address - Street 2:
Practice Address - City:COOLIDGE
Practice Address - State:AZ
Practice Address - Zip Code:85228
Practice Address - Country:US
Practice Address - Phone:520-723-4151
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:STATE OF ARIZONA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-11-12
Last Update Date:2024-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ010538Medicaid