Provider Demographics
NPI:1609064823
Name:CR RESORTS LLC
Entity Type:Organization
Organization Name:CR RESORTS LLC
Other - Org Name:TUCSON LENOX LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SVP - AUTHORIZED SIGNATORY
Authorized Official - Prefix:
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:
Authorized Official - Last Name:DITTMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-749-9655
Mailing Address - Street 1:8600 E ROCKCLIFF RD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85750-9733
Mailing Address - Country:US
Mailing Address - Phone:520-749-9655
Mailing Address - Fax:520-239-8515
Practice Address - Street 1:8600 E ROCKCLIFF RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85750-9733
Practice Address - Country:US
Practice Address - Phone:520-749-9655
Practice Address - Fax:520-239-8515
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-12
Last Update Date:2018-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
111N00000X
AZOTC1976207R00000X
AZOTC8497207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZH62534Medicare UPIN
AZA80378Medicare UPIN
AZC96066Medicare UPIN
AZF23669Medicare UPIN
AZI01764Medicare UPIN
AZT41453Medicare UPIN
AZD88955Medicare UPIN
AZU94441Medicare UPIN
AZT41562Medicare UPIN
AZG24656Medicare UPIN