Provider Demographics
NPI:1336444181
Name:STATE OF ARIZONA/STATE DEPT OF FINANCE
Entity Type:Organization
Organization Name:STATE OF ARIZONA/STATE DEPT OF FINANCE
Other - Org Name:ARIZONA STATE VETERAN HOME TUCSON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DEPUTY DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:M
Authorized Official - Last Name:BARNES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-255-3373
Mailing Address - Street 1:4141 NORTH S. HERRERA WAY
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85012
Mailing Address - Country:US
Mailing Address - Phone:520-638-2150
Mailing Address - Fax:520-638-2166
Practice Address - Street 1:555 EAST AJO WAY
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85713
Practice Address - Country:US
Practice Address - Phone:520-638-2150
Practice Address - Fax:520-638-2166
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-25
Last Update Date:2022-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZNCI-212314000000X
AZNCI212314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ691486Medicaid
035284Medicare PIN
AZ035284Medicare Oscar/Certification
AZ035284Medicare PIN