Provider Demographics
NPI:1992998348
Name:SAGUARO FOUNDATION
Entity type:Organization
Organization Name:SAGUARO FOUNDATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:KERRY
Authorized Official - Last Name:VAN GUILDER
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:928-783-6069
Mailing Address - Street 1:1495 S 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85364-4603
Mailing Address - Country:US
Mailing Address - Phone:928-783-6069
Mailing Address - Fax:928-782-0061
Practice Address - Street 1:1495 S 4TH AVE
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364-4603
Practice Address - Country:US
Practice Address - Phone:928-783-6069
Practice Address - Fax:928-782-0061
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-20
Last Update Date:2007-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities