Provider Demographics
NPI:1134622590
Name:UNITED COMMUNITY HEALTH CENTER-MARIA AUXILIADORA, INC.
Entity type:Organization
Organization Name:UNITED COMMUNITY HEALTH CENTER-MARIA AUXILIADORA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:RODOLFO
Authorized Official - Middle Name:
Authorized Official - Last Name:JIMENEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-407-5600
Mailing Address - Street 1:1260 S CAMPBELL AVE BLDG 2
Mailing Address - Street 2:
Mailing Address - City:GREEN VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85614-0503
Mailing Address - Country:US
Mailing Address - Phone:520-407-5606
Mailing Address - Fax:
Practice Address - Street 1:18857 S. LACANADA DR.
Practice Address - Street 2:
Practice Address - City:SAHUARITA
Practice Address - State:AZ
Practice Address - Zip Code:85629
Practice Address - Country:US
Practice Address - Phone:520-407-5800
Practice Address - Fax:520-407-5990
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-13
Last Update Date:2020-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty