Provider Demographics
NPI:1700809787
Name:CONTINENCE CENTER OF AMERICA INC
Entity Type:Organization
Organization Name:CONTINENCE CENTER OF AMERICA INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:ROSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:623-977-1212
Mailing Address - Street 1:PO BOX 54459
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85078-4459
Mailing Address - Country:US
Mailing Address - Phone:623-977-1212
Mailing Address - Fax:623-875-1815
Practice Address - Street 1:13000 N 103RD AVE STE 73
Practice Address - Street 2:
Practice Address - City:SUN CITY
Practice Address - State:AZ
Practice Address - Zip Code:85351-3056
Practice Address - Country:US
Practice Address - Phone:623-977-1212
Practice Address - Fax:623-875-1815
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-25
Last Update Date:2019-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ21641Medicare PIN
AZCI9548Medicare PIN