Provider Demographics
NPI:1598538308
Name:CASS SHELTER SERVICES
Entity Type:Organization
Organization Name:CASS SHELTER SERVICES
Other - Org Name:CASS
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:SMI ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:DEPRATO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-256-6945
Mailing Address - Street 1:PO BOX 18250
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85005-8250
Mailing Address - Country:US
Mailing Address - Phone:602-362-0661
Mailing Address - Fax:
Practice Address - Street 1:230 S 12TH AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85007-3101
Practice Address - Country:US
Practice Address - Phone:602-256-6945
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CENTRAL ARIZONA SHELTER SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-11-02
Last Update Date:2023-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health