Provider Demographics
NPI:1093240020
Name:COTTONWOOD TUCSON OUTPATIENT SERVICES
Entity Type:Organization
Organization Name:COTTONWOOD TUCSON OUTPATIENT SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR HEALTH INFO MGMT/COMPLIANC
Authorized Official - Prefix:MS
Authorized Official - First Name:EILEEN
Authorized Official - Middle Name:M
Authorized Official - Last Name:JACOBSON
Authorized Official - Suffix:
Authorized Official - Credentials:RHIT
Authorized Official - Phone:520-743-2162
Mailing Address - Street 1:4110 W SWEETWATER DR BLDG 16
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85745-9348
Mailing Address - Country:US
Mailing Address - Phone:520-743-0411
Mailing Address - Fax:520-743-7991
Practice Address - Street 1:4110 W SWEETWATER DR BLDG 16
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85745-9348
Practice Address - Country:US
Practice Address - Phone:520-743-0411
Practice Address - Fax:520-743-7991
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COTTONWOOD DE TUCSON, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-04-27
Last Update Date:2017-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZOTC7911261QM0850X, 261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health