Provider Demographics
NPI:1336244516
Name:MARSHALL HOME FOR MEN
Entity Type:Organization
Organization Name:MARSHALL HOME FOR MEN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOE
Authorized Official - Middle Name:D
Authorized Official - Last Name:CIMINO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-624-5193
Mailing Address - Street 1:3314 S 16TH AVE
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85713-5899
Mailing Address - Country:US
Mailing Address - Phone:520-624-5193
Mailing Address - Fax:520-882-2812
Practice Address - Street 1:3314 S 16TH AVE
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85713-5899
Practice Address - Country:US
Practice Address - Phone:520-624-5193
Practice Address - Fax:520-882-2812
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZALC 4335305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service