Provider Demographics
NPI:1972033793
Name:PIMA PREVENTION PARTNERSHIP
Entity Type:Organization
Organization Name:PIMA PREVENTION PARTNERSHIP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:RODNEY
Authorized Official - Middle Name:
Authorized Official - Last Name:COOK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-792-3293
Mailing Address - Street 1:1477 W COMMERCE CT
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85746-6016
Mailing Address - Country:US
Mailing Address - Phone:520-792-3293
Mailing Address - Fax:520-792-4336
Practice Address - Street 1:1346 N STONE AVE BLDG 2
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85705-7338
Practice Address - Country:US
Practice Address - Phone:520-792-3293
Practice Address - Fax:520-792-4336
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COPE COMMUNITY SERVICES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-06-14
Last Update Date:2019-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ274453Medicaid