Provider Demographics
| NPI: | 1740517713 |
|---|---|
| Name: | COMMUNITY PARTNERS INTEGRATED HEALTHCARE, INC. |
| Entity type: | Organization |
| Organization Name: | COMMUNITY PARTNERS INTEGRATED HEALTHCARE, INC. |
| Other - Org Name: | <UNAVAIL> |
| Other - Org Type: | |
| Authorized Official - Title/Position: | PRESIDENT AND CEO |
| Authorized Official - Prefix: | |
| Authorized Official - First Name: | ROSE |
| Authorized Official - Middle Name: | MARY |
| Authorized Official - Last Name: | LOPEZ |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | MBA |
| Authorized Official - Phone: | 520-721-1887 |
| Mailing Address - Street 1: | PO BOX 86537 |
| Mailing Address - Street 2: | |
| Mailing Address - City: | TUCSON |
| Mailing Address - State: | AZ |
| Mailing Address - Zip Code: | 85754-6537 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 520-721-1887 |
| Mailing Address - Fax: | 520-721-0069 |
| Practice Address - Street 1: | 1021 S KOFA AVE |
| Practice Address - Street 2: | |
| Practice Address - City: | PARKER |
| Practice Address - State: | AZ |
| Practice Address - Zip Code: | 85344-5021 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 928-376-0220 |
| Practice Address - Fax: | 928-669-2500 |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | Yes |
| Parent Organization LBN: | COMMUNITY PARTNERS INC |
| Parent Organization TIN: | <UNAVAIL> |
| Enumeration Date: | 2009-11-11 |
| Last Update Date: | 2020-04-20 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Licenses
| State | License ID | Taxonomies |
|---|---|---|
| AZ | OTC8051 | 251S00000X |
| 261Q00000X | ||
| AZ | BH-3474 | 101YM0800X, 101YP2500X, 103G00000X, 103T00000X, 103TB0200X, 103TC0700X, 103TC2200X, 103TF0000X, 103TM1800X, 103TP2701X, 104100000X, 1041C0700X, 251S00000X |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 251S00000X | Agencies | Community/Behavioral Health | Group - Multi-Specialty | |
| No | 261Q00000X | Ambulatory Health Care Facilities | Clinic/Center | Group - Multi-Specialty | |
| No | 101YM0800X | Behavioral Health & Social Service Providers | Counselor | Mental Health | Group - Multi-Specialty |
| No | 101YP2500X | Behavioral Health & Social Service Providers | Counselor | Professional | Group - Multi-Specialty |
| No | 103G00000X | Behavioral Health & Social Service Providers | Clinical Neuropsychologist | Group - Multi-Specialty | |
| No | 103T00000X | Behavioral Health & Social Service Providers | Psychologist | Group - Multi-Specialty | |
| No | 103TB0200X | Behavioral Health & Social Service Providers | Psychologist | Cognitive & Behavioral | Group - Multi-Specialty |
| No | 103TC0700X | Behavioral Health & Social Service Providers | Psychologist | Clinical | Group - Multi-Specialty |
| No | 103TC2200X | Behavioral Health & Social Service Providers | Psychologist | Clinical Child & Adolescent | Group - Multi-Specialty |
| No | 103TF0000X | Behavioral Health & Social Service Providers | Psychologist | Family | Group - Multi-Specialty |
| No | 103TM1800X | Behavioral Health & Social Service Providers | Psychologist | Intellectual & Developmental Disabilities | Group - Multi-Specialty |
| No | 103TP2701X | Behavioral Health & Social Service Providers | Psychologist | Group Psychotherapy | Group - Multi-Specialty |
| No | 104100000X | Behavioral Health & Social Service Providers | Social Worker | Group - Multi-Specialty | |
| No | 1041C0700X | Behavioral Health & Social Service Providers | Social Worker | Clinical | Group - Multi-Specialty |
Provider Identifiers
| State | Identifier ID | ID Type | Issuer |
|---|---|---|---|
| AZ | 232617 | Medicaid | |
| AZ | OTC8051 | Other | BUREAU OF MEDICAL FACILITIES LICENSING |
