Provider Demographics
NPI:1679944789
Name:PHOENIX RESIDENTIAL REENTRY AND COMMUNITY REINTEGRATION RESOURCE CENTE
Entity Type:Organization
Organization Name:PHOENIX RESIDENTIAL REENTRY AND COMMUNITY REINTEGRATION RESOURCE CENTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:
Authorized Official - Last Name:SANTOS
Authorized Official - Suffix:
Authorized Official - Credentials:ACCOUNTANT
Authorized Official - Phone:602-697-1489
Mailing Address - Street 1:2274 E SAHUARO DR
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85028-3117
Mailing Address - Country:US
Mailing Address - Phone:602-736-7383
Mailing Address - Fax:
Practice Address - Street 1:2274 E SAHUARO DR
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85028-3117
Practice Address - Country:US
Practice Address - Phone:602-736-7383
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-14
Last Update Date:2015-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251B00000X
AZ251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No251S00000XAgenciesCommunity/Behavioral Health