Provider Demographics
NPI:1457982647
Name:EL RIO SANTA CRUZ NEIGHBORHOOD HEALTH CENTER, INC
Entity Type:Organization
Organization Name:EL RIO SANTA CRUZ NEIGHBORHOOD HEALTH CENTER, INC
Other - Org Name:ST ELIZABETH'S HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:REVENUE CYCLE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CECILIA
Authorized Official - Middle Name:
Authorized Official - Last Name:CRUCE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-309-2718
Mailing Address - Street 1:839 W CONGRESS ST
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85745-2819
Mailing Address - Country:US
Mailing Address - Phone:520-670-3909
Mailing Address - Fax:520-670-3774
Practice Address - Street 1:140 W SPEEDWAY BLVD STE 100
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85705-7687
Practice Address - Country:US
Practice Address - Phone:520-628-7871
Practice Address - Fax:520-205-8461
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-28
Last Update Date:2020-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ007328Medicaid