Provider Demographics
NPI:1558678524
Name:PORTABLE PRACTICAL EDUCATIONAL PREPARATION, INC
Entity Type:Organization
Organization Name:PORTABLE PRACTICAL EDUCATIONAL PREPARATION, INC
Other - Org Name:ENCOMPASS
Other - Org Type:Other Name
Authorized Official - Title/Position:CAO
Authorized Official - Prefix:
Authorized Official - First Name:GINA
Authorized Official - Middle Name:
Authorized Official - Last Name:JUDY
Authorized Official - Suffix:
Authorized Official - Credentials:MAOM
Authorized Official - Phone:520-594-6499
Mailing Address - Street 1:901 E 46TH ST
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85713-5008
Mailing Address - Country:US
Mailing Address - Phone:520-594-6499
Mailing Address - Fax:520-622-0605
Practice Address - Street 1:901 E 46TH ST
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85713-5008
Practice Address - Country:US
Practice Address - Phone:520-594-6499
Practice Address - Fax:520-622-0605
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PORTABLE PRACTICAL EDUCATIONAL PREPARATION, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-09-10
Last Update Date:2010-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ251C00000X, 320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
No251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ007361OtherAHCCCS