Provider Demographics
NPI:1750450532
Name:AMERICAN INDIAN PREVENTION COALITION
Entity type:Organization
Organization Name:AMERICAN INDIAN PREVENTION COALITION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:BONNY
Authorized Official - Middle Name:M
Authorized Official - Last Name:BEACH
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:602-432-3098
Mailing Address - Street 1:PO BOX 25047
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85002-5047
Mailing Address - Country:US
Mailing Address - Phone:602-424-1600
Mailing Address - Fax:602-532-7202
Practice Address - Street 1:2302 N 7TH ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85006-1602
Practice Address - Country:US
Practice Address - Phone:602-424-1600
Practice Address - Fax:602-532-7202
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3245S0500X, 103T00000X, 101Y00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered3245S0500XResidential Treatment FacilitiesSubstance Abuse Rehabilitation FacilitySubstance Abuse Treatment, ChildrenGroup - Multi-Specialty
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
Not Answered101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
Not Answered207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ118168Medicaid
AZ777237Medicaid
AZ803925Medicaid
AZ790255Medicaid
AZ743733Medicaid
AZ189011Medicaid
AZ864729Medicaid