Provider Demographics
NPI:1346901956
Name:ARIZONA TRAINING PROGRAM @ COOLIDGE
Entity Type:Organization
Organization Name:ARIZONA TRAINING PROGRAM @ COOLIDGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF STATE OPERATED RESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-723-2638
Mailing Address - Street 1:2800 N. HWY 87
Mailing Address - Street 2:
Mailing Address - City:COOLIDGE
Mailing Address - State:AZ
Mailing Address - Zip Code:85128
Mailing Address - Country:US
Mailing Address - Phone:520-723-2600
Mailing Address - Fax:520-723-7618
Practice Address - Street 1:2800 N. HWY 87
Practice Address - Street 2:
Practice Address - City:COOLIDGE
Practice Address - State:AZ
Practice Address - Zip Code:85128
Practice Address - Country:US
Practice Address - Phone:520-723-2600
Practice Address - Fax:520-723-7618
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-05
Last Update Date:2022-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities