Provider Demographics
NPI:1831666783
Name:CAMPESINOS SIN FRONTERAS
Entity Type:Organization
Organization Name:CAMPESINOS SIN FRONTERAS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:EMMA
Authorized Official - Middle Name:
Authorized Official - Last Name:TORRES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-446-7817
Mailing Address - Street 1:PO BOX 423
Mailing Address - Street 2:
Mailing Address - City:SOMERTON
Mailing Address - State:AZ
Mailing Address - Zip Code:85350-0423
Mailing Address - Country:US
Mailing Address - Phone:928-627-5995
Mailing Address - Fax:928-627-1899
Practice Address - Street 1:663 E MAIN ST
Practice Address - Street 2:SUITE A
Practice Address - City:SOMERTON
Practice Address - State:AZ
Practice Address - Zip Code:85350
Practice Address - Country:US
Practice Address - Phone:928-627-5995
Practice Address - Fax:928-627-1899
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-30
Last Update Date:2021-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ102617Medicaid