Provider Demographics
NPI:1659823235
Name:CAREATC-PHOENIX
Entity Type:Organization
Organization Name:CAREATC-PHOENIX
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIR OF PURCHASING AND FACILITIES
Authorized Official - Prefix:
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:
Authorized Official - Last Name:GUCWA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-779-7416
Mailing Address - Street 1:3201 W PEORIA AVE
Mailing Address - Street 2:D707
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85029-4608
Mailing Address - Country:US
Mailing Address - Phone:602-354-8311
Mailing Address - Fax:
Practice Address - Street 1:3201 W PEORIA AVE
Practice Address - Street 2:D707
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85029-4608
Practice Address - Country:US
Practice Address - Phone:602-354-8311
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-28
Last Update Date:2016-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care