Provider Demographics
NPI:1043240435
Name:PEOPLE OF COLOR NETWORK
Entity Type:Organization
Organization Name:PEOPLE OF COLOR NETWORK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:ROMERO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-253-3084
Mailing Address - Street 1:609 N 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85003-1653
Mailing Address - Country:US
Mailing Address - Phone:602-253-3084
Mailing Address - Fax:602-253-3732
Practice Address - Street 1:609 N 2ND AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85003-1653
Practice Address - Country:US
Practice Address - Phone:602-253-3084
Practice Address - Fax:602-253-3732
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZBH2585251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ703547OtherAHCCCS PROVIDE NUMBER
AZ960882OtherAHCCCS GROUP BILLER