Provider Demographics
NPI:1578009759
Name:PARK PLACE OUTREACH & COUNSELING CENTERS, INC.
Entity Type:Organization
Organization Name:PARK PLACE OUTREACH & COUNSELING CENTERS, INC.
Other - Org Name:CASA DE VIDA
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:EARNEST
Authorized Official - Last Name:LINAFELTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-466-8850
Mailing Address - Street 1:P.O. BOX 2779
Mailing Address - Street 2:
Mailing Address - City:ARIZONA CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:85123
Mailing Address - Country:US
Mailing Address - Phone:520-466-8850
Mailing Address - Fax:520-466-8851
Practice Address - Street 1:15136 S AVALON RD
Practice Address - Street 2:
Practice Address - City:ARIZONA CITY
Practice Address - State:AZ
Practice Address - Zip Code:85123
Practice Address - Country:US
Practice Address - Phone:520-466-8850
Practice Address - Fax:520-466-8851
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PARK PLACE OUTREACH & COUNSELING CENTERS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-01-12
Last Update Date:2017-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ111902Medicare UPIN