Provider Demographics
NPI:1023852506
Name:CATHOLIC COMMUNITY SERVICES OF SOUTHERN ARIZONA, INC.
Entity type:Organization
Organization Name:CATHOLIC COMMUNITY SERVICES OF SOUTHERN ARIZONA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR QUALITY & COMP
Authorized Official - Prefix:
Authorized Official - First Name:EVA
Authorized Official - Middle Name:JASSO
Authorized Official - Last Name:MENDEZ-COUNTS
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:928-341-9400
Mailing Address - Street 1:268 W ADAMS ST
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85705-6534
Mailing Address - Country:US
Mailing Address - Phone:520-623-0344
Mailing Address - Fax:520-770-8514
Practice Address - Street 1:4550 S PALO VERDE RD BLDG 9
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85714-1943
Practice Address - Country:US
Practice Address - Phone:520-623-0344
Practice Address - Fax:520-770-8514
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CATHOLIC COMMUNITY SERVICES OF SOUTHERN ARIZONA, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-06-20
Last Update Date:2024-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty
No177F00000XOther Service ProvidersLodgingGroup - Multi-Specialty
No251B00000XAgenciesCase Management
No251S00000XAgenciesCommunity/Behavioral Health
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty