Provider Demographics
NPI:1851681118
Name:ORIGINS SOCIETY AND GLOBAL COLLEGE
Entity Type:Organization
Organization Name:ORIGINS SOCIETY AND GLOBAL COLLEGE
Other - Org Name:ORIGINS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:S
Authorized Official - Last Name:GITTINGS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:520-400-0987
Mailing Address - Street 1:2555 N EDITH BLVD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85716-2508
Mailing Address - Country:US
Mailing Address - Phone:520-881-1344
Mailing Address - Fax:520-203-8227
Practice Address - Street 1:2555 N EDITH BLVD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85716-2508
Practice Address - Country:US
Practice Address - Phone:520-881-1344
Practice Address - Fax:520-203-8227
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-07
Last Update Date:2011-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ06176320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities