Provider Demographics
NPI:1326272642
Name:PIA'S PLACE
Entity Type:Organization
Organization Name:PIA'S PLACE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:F
Authorized Official - Last Name:PENNY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:928-445-8400
Mailing Address - Street 1:615 W HILLSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86301-1936
Mailing Address - Country:US
Mailing Address - Phone:928-445-5081
Mailing Address - Fax:928-445-0395
Practice Address - Street 1:615 W HILLSIDE AVE
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86301-1936
Practice Address - Country:US
Practice Address - Phone:928-445-5081
Practice Address - Fax:928-445-0395
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-14
Last Update Date:2009-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZBH-922251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health