Provider Demographics
NPI:1255432183
Name:LA FRONTERA CENTER, INC.
Entity type:Organization
Organization Name:LA FRONTERA CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EVP/COO
Authorized Official - Prefix:MS
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:WELLS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-838-5501
Mailing Address - Street 1:502 W 29TH ST
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85713-3394
Mailing Address - Country:US
Mailing Address - Phone:520-838-5600
Mailing Address - Fax:520-792-0654
Practice Address - Street 1:10841 N THORNYDALE RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85742-8154
Practice Address - Country:US
Practice Address - Phone:520-572-9320
Practice Address - Fax:520-572-8978
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-25
Last Update Date:2024-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZBH-2642323P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZBH-2642OtherBH LICENSE
AZ083678Medicaid