Provider Demographics
NPI:1851623169
Name:RONALD MCDONALD HOUSE CHARITIES OF PHOENIX
Entity Type:Organization
Organization Name:RONALD MCDONALD HOUSE CHARITIES OF PHOENIX
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:PEREZ
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:602-264-2654
Mailing Address - Street 1:501 E ROANOKE AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85004-1013
Mailing Address - Country:US
Mailing Address - Phone:602-264-2654
Mailing Address - Fax:602-264-5670
Practice Address - Street 1:501 E ROANOKE AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85004-1013
Practice Address - Country:US
Practice Address - Phone:602-264-2654
Practice Address - Fax:602-264-5670
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-11
Last Update Date:2010-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ901563Medicaid