Provider Demographics
NPI:1093438053
Name:STATE OF ARIZONA/STATE DEPT OF FINANCE
Entity Type:Organization
Organization Name:STATE OF ARIZONA/STATE DEPT OF FINANCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CENTRAL BILLER
Authorized Official - Prefix:
Authorized Official - First Name:LAURIE
Authorized Official - Middle Name:A
Authorized Official - Last Name:CHAPMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-318-0920
Mailing Address - Street 1:2100 N GEMINI DR
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86001-1625
Mailing Address - Country:US
Mailing Address - Phone:602-255-3373
Mailing Address - Fax:
Practice Address - Street 1:2100 N GEMINI DR
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001-1625
Practice Address - Country:US
Practice Address - Phone:602-255-3373
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-23
Last Update Date:2022-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility