Provider Demographics
NPI:1083794564
Name:LA PALOMA FAMILY SERVICES
Entity Type:Organization
Organization Name:LA PALOMA FAMILY SERVICES
Other - Org Name:TIMROD GROUP HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:T
Authorized Official - Last Name:BRADLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-750-9667
Mailing Address - Street 1:880 S CRAYCROFT RD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85711-7111
Mailing Address - Country:US
Mailing Address - Phone:520-750-9667
Mailing Address - Fax:520-750-0056
Practice Address - Street 1:8400 E TIMROD ST
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85710-4255
Practice Address - Country:US
Practice Address - Phone:520-290-1821
Practice Address - Fax:520-750-0056
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZBH-612322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ649387Medicaid