Provider Demographics
NPI:1942539648
Name:YAVAPAI COUNTY
Entity Type:Organization
Organization Name:YAVAPAI COUNTY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMIN SUPERVISOR
Authorized Official - Prefix:MS
Authorized Official - First Name:VICKI
Authorized Official - Middle Name:
Authorized Official - Last Name:MASTRIANI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-771-3560
Mailing Address - Street 1:6717 E 2ND ST
Mailing Address - Street 2:SUITE D
Mailing Address - City:PRESCOTT VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:86314-2659
Mailing Address - Country:US
Mailing Address - Phone:928-771-3560
Mailing Address - Fax:928-771-3542
Practice Address - Street 1:6717 E 2ND ST
Practice Address - Street 2:SUITE D
Practice Address - City:PRESCOTT VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:86314-2659
Practice Address - Country:US
Practice Address - Phone:928-771-3560
Practice Address - Fax:928-771-3542
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-09
Last Update Date:2010-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ110025Medicaid