Provider Demographics
NPI:1629311634
Name:LA PALOMA FAMILY SERVICES, INC.
Entity Type:Organization
Organization Name:LA PALOMA FAMILY SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:WHITEHEAD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-206-8659
Mailing Address - Street 1:870 W MIRACLE MILE
Mailing Address - Street 2:BLDG 1
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85705-3708
Mailing Address - Country:US
Mailing Address - Phone:520-750-9667
Mailing Address - Fax:
Practice Address - Street 1:870 W MIRACLE MILE
Practice Address - Street 2:BLDG 1
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85705-3708
Practice Address - Country:US
Practice Address - Phone:520-750-9667
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-28
Last Update Date:2013-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4170322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ4170OtherOBHL