Provider Demographics
NPI:1851870828
Name:ANNE KNOOP RESPITE SERVICE
Entity Type:Organization
Organization Name:ANNE KNOOP RESPITE SERVICE
Other - Org Name:ANNE KNOOP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:KNOOP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-902-0743
Mailing Address - Street 1:4831 E HAMPTON ST
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85712-2725
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4831 E HAMPTON ST
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-2725
Practice Address - Country:US
Practice Address - Phone:317-902-0743
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ANNE KNOOP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-08-10
Last Update Date:2018-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZBH5312385HR2055X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385HR2055XRespite Care FacilityRespite CareRespite Care, Mental Illness, Child
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZBH5312OtherAZ DEPT OF HEALTH SERVICES