Provider Demographics
NPI:1013398411
Name:CACTUS HEALTH CARE SERVICES
Entity Type:Organization
Organization Name:CACTUS HEALTH CARE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MARILYN
Authorized Official - Middle Name:
Authorized Official - Last Name:EGBORO
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:602-245-0592
Mailing Address - Street 1:1335 W 13TH PL
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85281-6315
Mailing Address - Country:US
Mailing Address - Phone:602-509-6316
Mailing Address - Fax:
Practice Address - Street 1:8900 N CENTRAL AVE
Practice Address - Street 2:SUITE 107
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85020-2845
Practice Address - Country:US
Practice Address - Phone:602-245-0592
Practice Address - Fax:602-943-0864
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CACTUS HEALTH CARE SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-06-11
Last Update Date:2015-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ126978163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty