Provider Demographics
NPI:1679826291
Name:UNIVERSITY OF ARIZONARISE-RSSI
Entity Type:Organization
Organization Name:UNIVERSITY OF ARIZONARISE-RSSI
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF RISE
Authorized Official - Prefix:
Authorized Official - First Name:BETH
Authorized Official - Middle Name:C
Authorized Official - Last Name:STONEKING
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:520-626-7473
Mailing Address - Street 1:1450 N CHERRY
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85719-4207
Mailing Address - Country:US
Mailing Address - Phone:520-626-7473
Mailing Address - Fax:520-626-7833
Practice Address - Street 1:1450 N CHERRY AVE
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85719-4207
Practice Address - Country:US
Practice Address - Phone:520-626-7473
Practice Address - Fax:520-626-7833
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-19
Last Update Date:2012-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZCSA12ADHS0204251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZCSA12ADHS0204Medicaid