Provider Demographics
NPI:1629105705
Name:CASA DE LOS NINOS
Entity Type:Organization
Organization Name:CASA DE LOS NINOS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF CHILD AND FAMILY RESOUR
Authorized Official - Prefix:
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:
Authorized Official - Last Name:HAUSLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-624-5600
Mailing Address - Street 1:1101 N 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85705-7467
Mailing Address - Country:US
Mailing Address - Phone:520-624-5600
Mailing Address - Fax:520-623-2443
Practice Address - Street 1:1101 N 4TH AVE
Practice Address - Street 2:1138 N. 5TH AVE.
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85705-7467
Practice Address - Country:US
Practice Address - Phone:520-624-5600
Practice Address - Fax:520-623-2443
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-27
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZUNC-1216251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ07ADHS0189-1OtherCOMMUNITY SERVICES PROVI
AZ074928OtherAHCCCS
AZ385189OtherAHCCCS
AZ055780OtherAHCCCS
AZUNC-1216OtherADHS
AZ07ADHS0189-1OtherCOMMUNITY SERVICES PROVI