Provider Demographics
NPI:1043424278
Name:DANVILLE SERVICES OF ARIZONA, L.L.C.
Entity Type:Organization
Organization Name:DANVILLE SERVICES OF ARIZONA, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:STATE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:DANIEL
Authorized Official - Last Name:PADILLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-327-9889
Mailing Address - Street 1:17 W WETMORE RD
Mailing Address - Street 2:#201
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85705-1671
Mailing Address - Country:US
Mailing Address - Phone:520-327-9889
Mailing Address - Fax:520-320-0658
Practice Address - Street 1:17 W WETMORE RD
Practice Address - Street 2:#201
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85705-1671
Practice Address - Country:US
Practice Address - Phone:520-327-9889
Practice Address - Fax:520-320-0658
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ637978320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ644410OtherAHCCCS PROVIDER ID #
AZ637978OtherAHCCCS PROVIDER ID #