Provider Demographics
NPI:1881859536
Name:ARIZONA TRAINING PROGRAM - WINDSOR
Entity Type:Organization
Organization Name:ARIZONA TRAINING PROGRAM - WINDSOR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:
Authorized Official - Last Name:BRENT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-542-6857
Mailing Address - Street 1:1789 W JEFFERSON
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85005
Mailing Address - Country:US
Mailing Address - Phone:602-542-6857
Mailing Address - Fax:602-364-1322
Practice Address - Street 1:1750 E WINDSOR
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85006
Practice Address - Country:US
Practice Address - Phone:602-230-8197
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:STATE OF ARIZONA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-07-22
Last Update Date:2008-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ315P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ040022Medicaid