Provider Demographics
NPI:1386924371
Name:CASA GRANDE UNION HSD
Entity type:Organization
Organization Name:CASA GRANDE UNION HSD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ESS COUNSELOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JONAH
Authorized Official - Middle Name:M
Authorized Official - Last Name:GILLOOLY
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:520-836-8500
Mailing Address - Street 1:2730 N TREKELL RD
Mailing Address - Street 2:
Mailing Address - City:CASA GRANDE
Mailing Address - State:AZ
Mailing Address - Zip Code:85122-1019
Mailing Address - Country:US
Mailing Address - Phone:520-836-8500
Mailing Address - Fax:520-876-1199
Practice Address - Street 1:2730 N TREKELL RD
Practice Address - Street 2:
Practice Address - City:CASA GRANDE
Practice Address - State:AZ
Practice Address - Zip Code:85122-1019
Practice Address - Country:US
Practice Address - Phone:520-836-8500
Practice Address - Fax:520-876-1199
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-22
Last Update Date:2011-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLISAC-11537251S00000X
AZLCSW-12294251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health