Provider Demographics
NPI:1437195906
Name:NATIONAL COUNCIL ON ALCOHOLISM GREATER PHOENIX AREA
Entity Type:Organization
Organization Name:NATIONAL COUNCIL ON ALCOHOLISM GREATER PHOENIX AREA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:KOZIBA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-264-6214
Mailing Address - Street 1:4201 N 16TH ST
Mailing Address - Street 2:SUITE 140
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-5347
Mailing Address - Country:US
Mailing Address - Phone:602-264-6214
Mailing Address - Fax:602-265-2102
Practice Address - Street 1:4201 N 16TH ST
Practice Address - Street 2:SUITE 140
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-5347
Practice Address - Country:US
Practice Address - Phone:602-264-6214
Practice Address - Fax:602-265-2102
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-21
Last Update Date:2011-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZBH1887261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)