Provider Demographics
NPI:1932466356
Name:TEEN OUTREACH PREGNANCY SERVICES
Entity Type:Organization
Organization Name:TEEN OUTREACH PREGNANCY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:PEDERSEN
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:520-888-2881
Mailing Address - Street 1:3024 E FT LOWELL RD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85716-1572
Mailing Address - Country:US
Mailing Address - Phone:520-888-2881
Mailing Address - Fax:520-770-0035
Practice Address - Street 1:3024 E FT LOWELL RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85716-1572
Practice Address - Country:US
Practice Address - Phone:520-888-2881
Practice Address - Fax:520-770-0035
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-23
Last Update Date:2012-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN000099129251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ387268Medicaid