Provider Demographics
NPI:1336329895
Name:CAMP FIRE COUNCIL OF GREATER ARIZONA
Entity Type:Organization
Organization Name:CAMP FIRE COUNCIL OF GREATER ARIZONA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:
Authorized Official - Last Name:NOVICOFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-954-7544
Mailing Address - Street 1:5110 N 40TH ST
Mailing Address - Street 2:SUITE 107
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85018-2126
Mailing Address - Country:US
Mailing Address - Phone:602-954-7544
Mailing Address - Fax:602-954-7352
Practice Address - Street 1:5110 N 40TH ST
Practice Address - Street 2:SUITE 107
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85018-2126
Practice Address - Country:US
Practice Address - Phone:602-954-7544
Practice Address - Fax:602-954-7352
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-13
Last Update Date:2007-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ263488OtherAHCCS