Provider Demographics
NPI:1164863361
Name:PARKPLACE OUTREACH & COUNSELING CENTERS, INC.
Entity Type:Organization
Organization Name:PARKPLACE OUTREACH & COUNSELING CENTERS, INC.
Other - Org Name:CASA DE VIDA
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:EARNEST
Authorized Official - Last Name:LINAFELTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-466-8850
Mailing Address - Street 1:PO BOX 2779
Mailing Address - Street 2:
Mailing Address - City:ARIZONA CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:85123-1040
Mailing Address - Country:US
Mailing Address - Phone:520-466-8850
Mailing Address - Fax:520-466-8851
Practice Address - Street 1:11349 E 24TH LN
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85367-3633
Practice Address - Country:US
Practice Address - Phone:928-345-4777
Practice Address - Fax:520-466-8851
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PARK PLACE OUTREACH& COUNSELING CENTERS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-07-16
Last Update Date:2013-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZBH4308320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ111902Medicare UPIN