Provider Demographics
NPI:1770581639
Name:TON SANTA ROSA HEALTH CENTER
Entity type:Organization
Organization Name:TON SANTA ROSA HEALTH CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:VERONICA
Authorized Official - Middle Name:
Authorized Official - Last Name:GERONIMO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-547-8140
Mailing Address - Street 1:7900 S J STOCK RD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85746-7012
Mailing Address - Country:US
Mailing Address - Phone:520-547-8140
Mailing Address - Fax:
Practice Address - Street 1:FEDERAL ROUTE 15, MILEPOST 12
Practice Address - Street 2:
Practice Address - City:SELLS
Practice Address - State:AZ
Practice Address - Zip Code:85634
Practice Address - Country:US
Practice Address - Phone:520-361-2403
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-13
Last Update Date:2024-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ261QR1300X
261QP0904X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP0904XAmbulatory Health Care FacilitiesClinic/CenterPublic Health, Federal
No261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0109850OtherBC/BS AZ DENTAL PROV NO
AZ03D0864300OtherCLIA #
AZ1770581639OtherFACILITY PROVIDER #
AZ147141-03Medicaid
AZ0327177OtherNACADP#
AZAZ0490080OtherBC/BS AZ PROV NO
AZ0327177OtherNACADP#
AZHSZ171Medicare PIN