Provider Demographics
NPI:1467637199
Name:WESTCARE ARIZONA I, INC.
Entity Type:Organization
Organization Name:WESTCARE ARIZONA I, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AREA DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:
Authorized Official - Last Name:STEVENS
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:928-763-1945
Mailing Address - Street 1:821 HANCOCK RD STE 2
Mailing Address - Street 2:
Mailing Address - City:BULLHEAD CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86442-5034
Mailing Address - Country:US
Mailing Address - Phone:928-763-1945
Mailing Address - Fax:928-763-8809
Practice Address - Street 1:821 HANCOCK RD STE 2
Practice Address - Street 2:
Practice Address - City:BULLHEAD CITY
Practice Address - State:AZ
Practice Address - Zip Code:86442-5034
Practice Address - Country:US
Practice Address - Phone:928-763-1945
Practice Address - Fax:928-763-8809
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-31
Last Update Date:2007-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZBH-1730251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health