Provider Demographics
NPI:1235342205
Name:MARK YOUTH AND FAMILY CARE CAMPUS INC.
Entity Type:Organization
Organization Name:MARK YOUTH AND FAMILY CARE CAMPUS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:LEGGIO
Authorized Official - Suffix:
Authorized Official - Credentials:LISAC
Authorized Official - Phone:520-326-6182
Mailing Address - Street 1:4653 E PIMA ST
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85712-3437
Mailing Address - Country:US
Mailing Address - Phone:520-326-6182
Mailing Address - Fax:520-326-9034
Practice Address - Street 1:4653 E PIMA ST
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-3437
Practice Address - Country:US
Practice Address - Phone:520-326-6182
Practice Address - Fax:520-326-9034
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-07
Last Update Date:2009-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1054251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health