Provider Demographics
NPI:1700856390
Name:ASSIST TO INDEPENDENCE
Entity Type:Organization
Organization Name:ASSIST TO INDEPENDENCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LORRAINE
Authorized Official - Middle Name:JONES
Authorized Official - Last Name:NOLINE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-283-6290
Mailing Address - Street 1:PO BOX 4133
Mailing Address - Street 2:
Mailing Address - City:TUBA CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86045-4133
Mailing Address - Country:US
Mailing Address - Phone:928-283-6261
Mailing Address - Fax:928-283-6284
Practice Address - Street 1:EAST CEDAR AVENUE
Practice Address - Street 2:SE TUBA CITY INDIAN MEDICAL CENTER LOT
Practice Address - City:TUBA CITY
Practice Address - State:AZ
Practice Address - Zip Code:86045-4133
Practice Address - Country:US
Practice Address - Phone:928-283-6261
Practice Address - Fax:928-283-6284
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-25
Last Update Date:2014-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ03-028432Z332B00000X
AZ459512332BC3200X
AZ457730343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ459512Medicaid
AZ457730Medicaid
AZ775059Medicaid
AZ1319150001Medicare ID - Type Unspecified