Provider Demographics
NPI:1497000293
Name:SALT RIVER PIMA-MARICOPA INDIAN COMMUNITY
Entity Type:Organization
Organization Name:SALT RIVER PIMA-MARICOPA INDIAN COMMUNITY
Other - Org Name:SALT RIVER PIMA MARICOPA INDIAN COMMUNITY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:NICHOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:BLAKE
Authorized Official - Suffix:
Authorized Official - Credentials:REVENUE CYCLE
Authorized Official - Phone:480-362-6803
Mailing Address - Street 1:10005 E OSBORN RD
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85256-4019
Mailing Address - Country:US
Mailing Address - Phone:480-362-7400
Mailing Address - Fax:480-362-5950
Practice Address - Street 1:10005 E OSBORN RD
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85256-4019
Practice Address - Country:US
Practice Address - Phone:480-362-5500
Practice Address - Fax:480-362-5566
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-17
Last Update Date:2021-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ813333Medicaid