Provider Demographics
NPI:1366846917
Name:EL RIO SANTA CRUZ NEIGHBORHOOD HEALTH CENTER
Entity Type:Organization
Organization Name:EL RIO SANTA CRUZ NEIGHBORHOOD HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CLINTON
Authorized Official - Middle Name:
Authorized Official - Last Name:KUNTZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-670-3909
Mailing Address - Street 1:PO BOX 1231
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85702-1231
Mailing Address - Country:US
Mailing Address - Phone:520-670-3909
Mailing Address - Fax:520-670-3774
Practice Address - Street 1:839 W CONGRESS ST
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85745-2819
Practice Address - Country:US
Practice Address - Phone:520-670-3857
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:E L RIO SANTA CRUZ NEIGHBORHOOD HEALTH CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-10-10
Last Update Date:2023-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZOTC0006261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ031801Medicare Oscar/Certification