Provider Demographics
NPI:1790798924
Name:CASA DE TUCSON
Entity Type:Organization
Organization Name:CASA DE TUCSON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ANNE
Authorized Official - Middle Name:N
Authorized Official - Last Name:HOWARTH
Authorized Official - Suffix:
Authorized Official - Credentials:REGISTERED NURSE
Authorized Official - Phone:520-572-0404
Mailing Address - Street 1:3700 W GAILEY DR
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85741-2017
Mailing Address - Country:US
Mailing Address - Phone:520-572-0404
Mailing Address - Fax:520-572-0776
Practice Address - Street 1:3700 W GAILEY DR
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85741-2017
Practice Address - Country:US
Practice Address - Phone:520-572-0404
Practice Address - Fax:520-572-0776
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZBH-1941322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ57990OtherAHCCCS