Provider Demographics
NPI:1407928351
Name:WOMEN'S TRANSITION PROJECT, INC.
Entity Type:Organization
Organization Name:WOMEN'S TRANSITION PROJECT, INC.
Other - Org Name:RENAISSANCE HOUSE
Other - Org Type:Other Name
Authorized Official - Title/Position:CHIEF QUALITY MANAGEMENT OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:OLIVER
Authorized Official - Suffix:
Authorized Official - Credentials:CPC, RMM, ICD10CT-CM
Authorized Official - Phone:520-628-3400
Mailing Address - Street 1:2700 S 8TH AVE
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85713-4730
Mailing Address - Country:US
Mailing Address - Phone:520-628-3400
Mailing Address - Fax:520-628-3401
Practice Address - Street 1:240 O'HARA AVENUE
Practice Address - Street 2:
Practice Address - City:BISBEE
Practice Address - State:AZ
Practice Address - Zip Code:85603
Practice Address - Country:US
Practice Address - Phone:520-432-1771
Practice Address - Fax:520-432-4703
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PASADERA BEHAVIORAL HEALTH NETWORK, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-11-15
Last Update Date:2015-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZBH-2640324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZBH-2640OtherSTATE LICENSE
AZ989634Medicaid