Provider Demographics
NPI:1922166107
Name:COYOTE TASK FORCE
Entity Type:Organization
Organization Name:COYOTE TASK FORCE
Other - Org Name:OUR PLACE CLUBHOUSE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:
Authorized Official - Last Name:GROBE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-886-5553
Mailing Address - Street 1:66 E PENNINGTON STREET, COYOTE TASKFORCE CORP
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85701
Mailing Address - Country:US
Mailing Address - Phone:520-884-5553
Mailing Address - Fax:520-670-1496
Practice Address - Street 1:66 E PENNINGTON STREET, COYOTE TASKFORCE CORP
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85701
Practice Address - Country:US
Practice Address - Phone:520-884-5553
Practice Address - Fax:520-670-1496
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-04
Last Update Date:2021-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health