Provider Demographics
NPI: | 1275942823 |
---|---|
Name: | CENTRAL ARIZONA SHELTER SERVICES |
Entity Type: | Organization |
Organization Name: | CENTRAL ARIZONA SHELTER SERVICES |
Other - Org Name: | CASS |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | COO |
Authorized Official - Prefix: | |
Authorized Official - First Name: | TERRY |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | SMITH |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 602-256-6533 |
Mailing Address - Street 1: | 230 S 12TH AVE |
Mailing Address - Street 2: | |
Mailing Address - City: | PHOENIX |
Mailing Address - State: | AZ |
Mailing Address - Zip Code: | 85007-3101 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 602-256-6945 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 230 S 12TH AVE |
Practice Address - Street 2: | |
Practice Address - City: | PHOENIX |
Practice Address - State: | AZ |
Practice Address - Zip Code: | 85007-3101 |
Practice Address - Country: | US |
Practice Address - Phone: | 602-256-6945 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2014-08-07 |
Last Update Date: | 2021-09-28 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 1223P0221X | Dental Providers | Dentist | Pediatric Dentistry | Group - Multi-Specialty |
Yes | 251S00000X | Agencies | Community/Behavioral Health | Group - Multi-Specialty |